WI0500181_GEOTHERMAL_20171219

Permit Number
Program Category
Ground Water
Permit Type
WI0500181
Injection Heating/Cooling Water Return Well
Primary Revle-r
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
William and Persis Dyson
Location Address
2100 Dimmocks Mill Rd
Hillsborough
Owner
Owner Name
William
Dates/Events
NC
Orig Issue
4/11/2008
App Received
9/6/2017
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27278
Dyson
D r(lft h:iltiated
Scheduled
Issuance Public Notice
Central Files: APS SVVP
12/19/2017
Permit Tracking Slip
Status
Active
Version
3.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affillatlon
Wiliam Dyson
2100 Dim mocks Mill Rd
Hillsborough
Region
Raleigh
County
Orange
NC
Issue
12/15/2017
Effective
12/15/2017
27278
Expiration
11/30/2022
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
9nt17
12/13/17
Subbasin
Permit Number
Program Category
Ground Water
Permit Type
WI0500181
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
William and Persis Dyson
Location Address
2100 Dimmocks Mill Rd
Hillsborough NC
Owner
Owner Name
William
Dates/Events
Orig Issue
4/11/2008
App Received
9/6/2017
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27278
Dyson
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
12/14/2017
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Afflllatlon
William Dyson
2100 Dimmocks Mill Rd
Hillsborough
Region
Raleigh
County
Orange
NC
Issue Effective
27278
Expiration
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
9nt17
12/13/17
Subbasln
Water Resources
Environmental Quality
December 15, 2017
William & Persis Dyson
2100 Dimmocks Mill Rd
Hillsborough, NC 27278
Re: Issuance of Injection Well Permit
Permit No, W10500181
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Mr. and Mrs. Dyson:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretor},
LINDA CULPEPPER
Interim Director
In accordance with your permit renewal application received on September 5, 2017 1 am forwarding
Permit No. WI0500181 for the continued operation of geothermal heating/cooling water return wells)
located at the above referenced address. This permit shall be effective from date of issuance, until
November 30, 2022 and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on October 11, 2017. Laboratory analytical results will be forwarded to
you when it becomes available.
in order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources- if you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
J :1
5hristi Shrestha
Underground Injection Control (UIC)- Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
—�'NrA.hi:tq conlParVrt
State of North Carolina I Eaviroamontal Quality I Division of Water Resaurm
Water Quality Reglnnal013c ations 5ectioa
1636 Mail Service Center I Raleigh, North Carolina 27699.1636
919-707-9129

cc: Rick Bolich -Laura Robertson, Raleigh Regional Office
Central Office File, WIOSOO 181
Orange County Environmental Health Department
l►[+]ORd:K4amiilft1 r1
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HERESY GRANTED TO
William and Persis Dyson
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), dermed in Title l 5A North Carolina Administrative Code 02C .0224(a), which will be used
for the injection of heat pump effluent. The injection well(s) located at 2100 Dimmocks Mill Rd, Hillsborough,
Orange County, NC 27278 will be operated in accordance with the application submitted September 5, 2017 and
in conformity with the specifications and supporting data received, all of which are filed with the Department of
Environmental Quality and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until November 30, 2022, and shall
be subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 151 day of December 2017.
y
For Linda Culpepper
Interim Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Perrrtit #WI0500181 UIC15A7 Pap 1 of 5
ver. 11115/2015

PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the facility
to change ownership, or there is a name change of the Permittee, a formal permit amendment request must
be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change [15A NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal.any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[15A NCAC .0225(g)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
6. Each well shall have permanently affixed an identification plate [ 15A NCAC 02C .0107G)(2)].
Pennit#WI0500181 UIC/5A7
ver. 11/15/2015
Page 2 of5
7 . A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit.
PART III-OPERATION AND USE CONDITIONS
1. The Pennittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .021 l(i)].
2. The issuance of this permit shall not relieve the Pennittee of the responsibility for damages to surface water
or groundwater resulting from the operation of this facility. In the event that the facility fails to perform
satisfactorily, including the creation of nuisance conditions or failure of the injection zone to adequately
assimilate the injected fluid, the Permittee shall take immediate corrective actions that may be required,
such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C .0206].
PART IV-INSPECTIONS[l5ANCAC 02C .021l(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [ 15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(l )] .
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality standards, or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .021 l(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below .
Pennit#WI0500181 UIC/5A7
ver. 11/15/2015
Page 3 of5
(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [15A NCAC 02C .0224(f)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
PART VI-PERMIT RENEWAL [15ANCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Permittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall permanently abandon that injection well in accordance with the procedures specified in 15A
NCAC 02C .0113(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
Pennit#WI0500181 UIC/5A7
ver. 11/15/2015
Page 4 of5
(C) Each well shall be thoroughly disinfected prior to sealing in accordance with rule 15A
NCAC 02C .011 l(b)(l)(A),(B), and (C).
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In those cases when a subsurface cavity has been created as a result of the injection
operations, each well shall be abandoned in such a manner that will prevent the movement
of fluids into or between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Pennit#WI0500181 UIC/5A7
ver. 11/15 /2015
Page 5 of5
m
WQRQS REGIONAL STAFF REPORT FORM
i3IC Program Support
Permit No, WI0500181
Date: 12/1312017 County: Grange
To: Shristi Shrestha Permittee/Applicant: William & Persis Dyson
Central Office Reviewer Facility Name: Dyson Geothermal Well
L GENERAL INFORMATION
1, This application. is (chrck all that npvly): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 10-11-2017
b. Person contacted and contact information: William D%son_ wmdvson(c�,bellsouth.ne1
c. Site visit conducted by: Laura Robertson Elliott
d. Inspection Report Printed from BiMS attached: ❑ Yes ® No
e. Physical Address of Site including zip code: 2100 Dimmocks Mill Road,_ Hillsborough. NC 2727E
I; Driving Directions if rural site and/or no physical address:
g. Latitude: 36.047554 Longitude;-79.136349
Source of I.at/Long & accuracy (i.e„ Google Eanh, GPS, etc.): Gooele Earth
11. DESCRIPTION OF INJECTION FELL S AND FACILITY
1. Type of injection system:
[] Geothermal i-Ieating/Cooling Water Return
{] In silty Groundwater Remediation RECEiVEONCOEG/DWA
❑ Norc-Discharge Groundwater Remediation .,
❑ y Other (Specify-_ _ ) DECu 2 17
2, For Geothermal Water Return Well(s) only wa4r Quallry
'��rJ10nal opermtwnos Sactlrvf
a. For existing geothermal system:
Were samples collected from Influent Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag: No Well Tao Visible.
b. Does existing or proposed system use same well for water source and injection? Z Yes ❑ No
If No, please provide source -'supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection weal and any other
features in Section IF of this StaIT Report.
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)?
What is the distance of the injection wells) from the pollution source(s)? _ v
4. What is the minimum distance of rp oposed injection wells from the property boundary?
5. (duality of drainage at site: ® Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ® Low ❑ Moderate ❑ High
Rev. 61.2015
Page t

WQROS REGIONAL STAFF REPORT FORM
UiC Program Support
7. For Groundwater Remedial ion systems, is the proposed andlor existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater -
monitoring program.
5. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ❑ Yes ❑ No. If No, or no map, please attach a sketch of the site. Show properly boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9- For Nan -Discharge groundwater remediat ion systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ N A.
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the sail scientist and/or Professional Engineer`s ❑ Yes ❑ No ❑ N A. If no, please explain:
III. EVALUATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance, renewal of this permit? ❑ Yes ®No. Ifyes, explain. _
?. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
I trm - --- - - -- . �. � .. Reason.
3. List specific special conditions or compliance schedules that you recommend to be included in [lie permit when
issued. Make sure that you provide a reason for each special condition:
Condition ----� — Reason
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
❑C issue
5. Signature of report preparer(s): _
Signature of WQROS Regional Supervisor: -
r
Date:
nev, 6 1 2015 Page 2

WQROS REGIONAL STAFF REPORT FORM
UIC Program Support
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (/[Needed)
-The well appears to be in very good condition, and is protected by a large well cover. The pad is in good
condition and well-maintained.
-The homeowners use a water softener at the home's point of entry.
-There is an irrigation well near the garden that is approximately 300 feet deep, and is protected by a large well
cover.
Rev. 6f l 2015 Page3
WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: September 7, 2017
To: Rick Bolich-Laura Robertson
From: Shristi Shrestha, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0500181
A. Applicant: William & Persis Dyson
B. Facili ty Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other. Information:
__ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-W OROS Reviewer: Date: ------------------------
COMMENTS:
NOTES: Please attach a copy of GW-1 form if available.
FORM: WQROS-ARR ver. 092614 Page 1 of 1
Water Resources
Envirmmenial Quality
September 7, 2017
William & Persis Dyson
2100 Dimmocks Mill Road
Hillsborough, NC 27278
RE: Acknowledgement of Application No. W10500181
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Mr. and Mrs. Dyson:
ROY COOPER
Governor
MICHAEL S. REGAN
secrelwy
S. JAY ZD4MERMAN
Dfrector
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on September 5 2017. Your application
package has been assigned the number listed above, and the primary reviewer is Shristi Shrestha
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximurn
efficiency in processing permit applications, the Water Quality Regional Operations Section
(WQROS) requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact Shristi
Shrestha at 919-807-6406 or email at [e-mail].
Sincerely,
J -1
For Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch Division of Water
Resources
cc: Raleigh Regional Office, WQROS
Permit File W10500181
'Nol lii. Co.
State of Wot1h Carolina I FAvironmental Quality I Diwioa of Rater Peso=es
Water Quality Regional operations section
1636 Mail Service Center { Raleigh, North Carolina 27699-1636
919-7( 7-9129

North Carolina Department of Environmental Quality - Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordwice With the Provisions of 1 SA NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S)
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
_New Application V Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Sections A thru E_ and M (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible applications Will Be Resumed As Incomplete.
DATE: e% � . 20 //;' PERMIT NO. kV.1U S D a 181 {leave blank if New Application)
A. CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continue to use the well as [Geothermal Well [Drinking Water Supply Well
❑ Other Water Supply Use- Indicate use (i.e., irrigation, etc.)
b. Terminate Use: If the well is no longer being used as a geothermal inje
rescind the permit, check the box below. If abandoned, attach a copy o
Record (GW-30). S E Q 5 2017
❑ Yes, I wish to rescind the permit Water ()uality Regional
2. Current Ownership Status pperations Section
Has there been a change of ownership since permit last issued? ❑ YES ffNO
If yes, indicate New Owner's contact information:
Name(s)
Mailing Address:
City:
Day Tele No.:
Zip Code: County,
Email Address.:
B. STATUS OF APPLICANT (choose one)
Nan -Government: Individual Residence Business/Organization
Government: State Municipal County Federal
C. WELL OWNER(S)IPERMiT APPLICANT — For single family residences, list all persons listed on the
property deed. For all others, list name of business/agency and name of person and title with delegated authority
to sign: 6EAZ ZAAA4 4. A7rCMAI f _ f �,tS/ ` M. D )r_5v e*1 -
Mailing Address: _21,V .01/w,'IlfmrC..5 n9/Zd '4044
City: State: A/C Zip Code: Z 727e- County: Q. 4ti/C
Day Tele No.: e2 / 9 — 7,7,,9 - 26 4 3 Cell No.: 31 -_5W — leffl
EMAU, Address: Gcisr+ y- Sept 0 s6e/6oc,11A, l e/Fax No.: -
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 1

/~£
D. WELL OPERA TOR (if different from well owner). -For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: o.J IL C. 1 ;d./4t' < ,_JJ Y...f Q u <f ? m.;1 J ,f1X .Ll Y5 (!1 V
Mailing Address:--------------------------------
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Email Address.:
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site: :J 8.5 3 9 ~SI 2 3 County: c)RANGe
(2) Physical Address (if different than mailing address): ________________ _
City: ____________ County _________ Zip Code: ____ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: _________________________ _
NC Well Drilling Contractor Certification No.:
Company Name: _______________________________ _
Contact Person-'-: --------------~EMAIL Address: ___________ _
Address:----------------------------------
City: _________ Zip Code: ____ State: __ County: ________ _
Office Tele No.: Cell No.: Fax No.: ________ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HV AC Contractor's Name: ___________________________ _
NC HV AC Contractor License No.: -------------------------
Company Name: _______________________________ _
Contact Person-'-: _______________ EMAIL Address: ___________ _
Address: __________________________________ _
City: _________ Zip Code: ____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ----------------
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES __ _
YES __ _
NO ___ _
NO ----
I. WELL CONSTRUCTION REQUIREMENTS-As specified in 15A NCAC 02C .0224 (d):
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
Geothermal Water Return Well Pennit Application Rev. 4-15-2016 Page 2
(a) For screen and gravel-packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b). For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
*EXISTING WELLS ------------'PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
(t) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in 15A NCAC 02C .0224{b)(4 ). attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map shall
include the following:
( 1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107(a)(2 ) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 3
NOTE,- In most cases an aerial photograph of the property parcel showing property [in es and structures can be
obtained aced downloaded from the applicable county GIS web sita Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic taroks, other
wells, etc. can then be drawn in by hanA Also, a `layer' can be selected showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
ISA NCAC 02C .4211 I e 1 requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected. official;
4. for all others: by all the_person(_s) listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that naives and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
permit."
Signature of Property Owner pplicant v
Print or Type Full Name and Title
Signature of Property OwnerlAr4s icant
Print or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
C=thermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

GEOTHERMAL HEATING/COOLING WELL CONSTRUCTION DETAIL
Choose applicable Injection Well design and check the appropriate boxes. Fill in depths below land surface (BLS) and
details of well construction on the blank lines provided Use additional sheets as needed.
Oven -Hole Well Design
LJ Proposed F1 Existing
❑ Injection; ❑ Supply;
❑ Dual Purpose
Record Depths Below
Land surface (BLS)
on Lines Provided
Bottom of casing
(Ft. BLS) -
Total Depth
(FL BLS)
Return or Supply Line
Casing
Grout
WELL DETAILS
Casing Material:
Casing Diameter (in.):
Grout Type:
Grout Depth (BLS):
Top of Bentonite Seal (if present):
Bottom of Bentonite Seal
Screen Material:
Screen Slot Size (in.):
Sand/Gravel Pack
Material Type:
Bedrock
Hole
Bentonite Seal
ff present)
Sand/Gravel Pack
Screen
Screened Well Design
Proposed LJ Existing
❑ Injection; ❑ Supply;
❑ Dual Purpose
(Ft.)
Record Depths Below
Land Surface (111.5) on
Lines Provided
(Ft. BLS)
(Ft BI.S)
Bottom of casing
(Ft. BLS)
(Total Depth
Ft, BLS)
NC Certified Well Driller Name: Certification No.:

Nra
Water Resources
1~nvimtmental Quality
August 22, 2017
CERTIFIED MAIL # 7012 1640 0000 9792 3100
RETURN RECEIPT REQUESTED
William & Persis Dyson
2100 Dimmocks Mill Rd
Hillsborough, NC 27278
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0500181
Orange County
Dear Mr. and Mrs. Dyson:
ROY COOPER
Governor
MICHAEL 5_ REGAN
Secrelary
S. JAY ZMAERMAN
Director
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on November 11, 2017 and expires on November 30, 2017. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
calendar days prior to expiration of the permit if you wish to continue operating the injection well
on your property.
If Your Geothermal Water Return Well is Still Currently Being Used for tnlection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 1 SA, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells — Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
h tt p : //portal. ncdenr. grgZweb/wg /ap s/ gwpro/permit-applications.
_'�" 1Vnthinq Compare.;
State of North Carolina { Environmental Quality I Division of Water Resources
Rater Quality Wonal ❑perations 3ecti00
1636 Mail Service Center I Ralcig, North Carolina 27699-1636
914 707-9129

If Your Geothermal Water Return Well is NO LONGER Being Used for Infection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.), If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 1 SA, Subchapter 2C, Section
.0240. When the well is plugged and abandoned, a well abandonment record (Form GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
If There _has _been a Change of Ownership of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
LIIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessmetit of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at slzristi.shresthat�ncdenr.goy.
Regards,
011Mduq
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Raleigh- Regional Office — WQROS wto enclosures
Central Files - Permit No. WI0500181 w/o enclosures

Postal
CERTIFIED MAIL,,, RECEIPT
= /. R
M EIRIMI MOM,
ru
IT
fl- Postage S
Ir
Certified Fee
Q Postmark
r7-3 Return Recelpt Fee Here
Ira (Endorsement Rego?red)
O
Reerricted Delivery Fee
Q tEndorsementRequlredi
�
rntalPosragc William & Persis Dyson
ru Te 2100 Dimmocks Mill Rd
street;Vt Na:; Hillsborough, NC 27278
r.. uP Pa Bax No.
PS ForM
ClfjS Sipta, 7JRr
:00 ,r. see Reverse for tnsiructic,
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address an the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpier e,
or on the front if space permits.
1. Article Addressed to:
William & ,°er:�is Dyson
2100 Dirm)rrozks Mill Rd
Hillsborough, NC 27278
A Signature
x :J ,
❑ Agent
❑ Addressee
B. Received by (FWntedt Name) C. Data of Delivery
pi�FIV:�'l�?. �. --,-OA
D. is dekvery address different-f m items 1? Ci yes
If YES, eater delivery address below: ❑ No
AUG 2 9 2017
3- Service Type
❑ Certltivd mali ❑ Evress Mal!
❑ Registow ❑ Return Receipt far Merchandise
❑ lneured ;Mail 0 O.O.D.
4. Restricted Deeveryi' (Extra Fee) ❑ yes
2. Article Number 7012 1640 ODOU 9792 3100
[Transfer from service 14W
P5 Form 3811, February 2004 Domestic Return Reeelpt 102W5-02-M-1540

JNioSOCJt8/
WQROS REGIONAL STAFF REPORT FORM
.UIC Program Support
Permit No. WI0500181
Date: 12/13/2017
To: Shristi Shrestha
Central Office Reviewer
County: Orange
Permittee/ Applicant: \Villiam & Persis Dyson
Facility Name: Dyson Geothermal Well
L GENERAL INFORMATION
1. This application is· (check all that apply): D New [gj Renewal
D Minor Modification D Major Modification
a. Date of Inspection: 10-11-2017
b. Person contacted and contact information: William D vson. wmd" son a, bellsouth.net
c. Site visit conducted by: Laura Robertson Elliott
d. Inspection Report Printed from BIMS attached: D Yes [gj No
e. Physical Address of Site including zip code: 2100 Dimrnocks Mill Road. Hillsboroucli. NC 27278
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 36.047554 Longitude: -79.136349
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.):
II. DESCRIPTION OF INJECTION WELL (S ) AND FACILITY
1. Type of injection system:
[gj Geothermal Heating/Cooling Water Return
D In situ Groundwater Remediation
D Non-Discharge Groundwater Remediation
D Other (Specify: )
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
Goo e le Earth
RECEfVED/NCDEQ/DWR
DEC l 8,2017
Water Q~ality Regional
Operations Section
Were samples collected from Influent/Effluent sampling ports? [gj Yes D No.
Provide well construction information from well tag: No Well TaQ" Visible.
b. Does existing or proposed system use same well for water source and injection? [gj Yes D No
If No, please provide source/supply well construction info (i.e ., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? D Yes [gj No
What is/are the pollution source(s)? _________________________ _
What is the distance of the injection well(s) from the pollution source(s)?
4. What is the minimum distance of proposed injection wells from the property boundary? ______ _
5. Quality of drainage at site: ~ Good D Adequate D Poor
6. Flooding potential of site: [gj Low D Moderate D High
Rev. 6/1/2015 Page 1
WQROS REGIONAL STAFF REPORT FORM
UIC Program Support
7. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. If No,
attach snap of existing monitoring well network if applicable and recommend any changes to the groundwater -
monitoring program.
S. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ❑ Yes ❑ No. If No, or no rnap, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non -Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ N/A.
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the suit scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ N/A. If no, please explain.
III, EVAL UATIdNA1VD RECaMiVENDATIDNS
1. Do you foresee any problems with issuance/renewal of this permit? [:)Yes ®No. If yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition.:
Condition Reason
I
4. Recommendation
❑ Deny_ HDeny, please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
® Issue
5. Signature of report preparer(s):
Signature of WQROS Regional Supervisor:
Date: I
Rev. 6/1/2015 gage 2

WQROS REGIONAL STAFF REPORT FORM
UIC Program Support
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTSIATTACHJl,IENTS (l(NeededJ
-The well appears to be in very good condition, and is protected by a large well cover. The pad is in good
condition and well-maintained.
-The homeowners use a water softener at the home's point of entry.
-There is an irrigation well near the garden that is approximately 300 feet deep, and is protected by a large well
cover.
Rev. 6/1/2015 Page 3
AC43914
Loe. Oescr.:
County:
Region:
River Basm
Emergency
COC YesiNo
"Korth Carolina Division of Water Resources Wati;:r Sciences Section Lab QI;!_tOI}'. Results
WILLIAM DYSON 2100 DlMMOCKS MILL RD
Orange Collector.
BRQ Report To
!ill! Collect Data;
CollectTm,e
Sample Depth
LROBERTSON
RRO
1.9.l.1filQ:!1
09:20
Vist llD
Location 10· SPOG8WI0500181 IN
Priority COMPLIANCE
Sample M~tr1x GROUNDWATER
Loe. Type Watar Supply
Final Re Qort
3a rrple 'D·
.=>Q ;<1umb0r /t.
~
10,1112017
:me qacer1ed ~
,.abwcrks L,J1J1nlD MSWIF'T
:Jeli-.,~r, \let1'od Hand 0alivered
;:;nal Report ·:)ate 11/3/H
.1.:!i9l.!Wl
If this report is labeled preliminary report, the results have not been validate d, Do not use for Regulatory p u rposes.
CAS#
7429-90-5
7440-70~2
744047-3
7440-50-8
7439-89-6
7440-09-7
7439-95-4
7439--96-5
7440-02-0
7439-92-1
7440-66-6
Result/ Units Method Analysis
Ana l-.I e Name POL Qualifier Reference Date
LAB
·Sample temperal~re at receipt by lab 3,1 'C 10i12:17
MIC
Colifonm, MF Fecal in liquid 1 B2 S1\.l 10111·17
Coliform, MF Total in liquid 1 B2 CFU:~C(;rnl SM 9222 B-1997 10{11:17
NUT
NO2+NO3 as Nin liquid 0.02 0.02 U mg1Las N ,.;;:.a, ..... ~.= 10(17:17
WET
Bromide 0,4 0,4 U ~ 10/18/17
Chloride 1.0 2.7 mgil_ 10..'18!17
Fluoride 0.4 0.72 mg;L 10;1a1~7
Sulfate 2.0 140 ,TSgiL EPA 3CO ·J ;~'12 · 10.-~ 3; 17
Tola! Dissolved Solids in liquid 12 410 mgil SM 2:1:..10 C-1:!Y 7 1•];11.-17
MET
Al by ICP 50 50 U :,..g:L E?A. 200 ? R~·~4 -1-11),2.'.3.'17
Ca by ICP 0.10 77 mg,L EPA 2CO 7 R;;H4 -' 10i2Ji1 7
Crby ICPMS 5,0 5,0 U u91L EPA 200.3 Rs··l?.-1-10120/1 7
Cu by ICPMS 2.0 8.9 ,;gIL i:?A 2~0.8 Re·-15 -1-10,2on1
Fe by ICP 50 50 U t.gl L i:PA 200. 7 Re•,4 .-1 1Di2'3t~7
K by ICP 0,10 0.49 mg/L E?A 20G.7 Re•14.~ 10123117
Mg by ICP 0.10 1.7 mgll EPA 2C-O 7 Rev4 .i
Mn by ICP 10 10 U •Jg/L E F'A 200 . 7 Re•,;4.-$ 10:23/17
Ni by ICPMS 2.0 2.0 U EPA 21JG.a Re•,5.4 10/20/17
Pb by ICPMS 2.0 2.0 U .Jgt L EPA 2DO 3 Re·,5.'1 10/20!1!
Zn by ICPMS 10 300 EPA 20:::0 . .S Re•·i5 .4 10,'2Q!17
WSS Chemistry Laboratory>:> 1623 Mail Service Center, Rala lgh, NC 27699-1623 {913) 733·3908
''Not Detected• or ~u" does· nol indicate the sample is analyte rree but ttiat !he
Page 1 of 1
3l or ,1bn•ie u·,e POL.
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Lac. oascr..
VnLWA-M gVAC�N 4ip0 DWW09K¢ MILL RP
AGd3913
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1011112017
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roMPUANCE
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It lilts report is labeled preliminary report, the results have no been validated. Do not use for Regulatory purposes.
ResuRl Niethod AnaNsis
tm is
CAS 9 Anal::e_Mame PQL Queilfier Ratgrerre ote
LAB
Sample temperature at receipt by lab 3.1
PGAUTHER
Colliorm, MF decal In ilquld
1
MiC
1 B2
sa4322T G•1397
Collfarm, MF Total in Rquid
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Water Resources
ENVIRONMENTAL GUAl!TY
December 13, 2017
William & Persis Dyson
2100 Dimmocks Mill Road
Hillsborough, NC 27278
Subject: Geothermal Well Sampling Results
WI0500181
2100 Dimmocks Mill Road
Hillsborough, NC -Orange County
Dear Mr. and Mrs. Dyson:
ROY COOPER
~HCHAEL S. REGAN
LINDA CULPEPPER
Groundwater sampling was conducted at the geothermal well on your property on October
11, 2017. We are forwarding herewith the laboratory reports dated November 3, 2017, issued for
the following analyses in the influent and effluent samples: fecal and total coliform bacteria,
chloride, fluoride, sulfate, total dissolved solids (TDS), nitrate-nitrite as N, and metals.
The laboratory results indicate that chloride, fluoride, sulfate, total dissolved solids (TDS),
nitrate-nitrite as N, and metals tested were all within the 15A NCAC 02L .0202 Groundwater
Standards in the samples collected on October 11, 2017. Fecal and Total Coliform Bacteria were
not detected in either sample.
Please find the attached laboratory results. Feel free to contact me with any questions.
Enclosure: Lab Report
cc: RRO Files
Sincerely,
Laura Robertson Elliott, LG
Hydro geologist
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
Orange County Environmental Health
State of North Carolina Environmental Quality I Water Resources
1628 Mail Service Center I Raleigh, North Carolina 27699-1628
919 791 4200
5A�
A��M��r_
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P, E
John E. Skvarla, III
Governor Director
Secretary
March 11, 2013
William Dyson
2100 Dimmocks Mill Road
Hillsborough, NC 27278
Subject: Analytical Results of Well Water
Permit No. W10500181
Geothermal Heating/Cooling Water
Well
Grange County
Dear Mr. Dyson,
Enclosed please find the analytical results of the subject well water which was sampled on December
12, 2012. The influent {groundwater entering heat pump} and the effluent (groundwater being injected
into the well) of the geothermal well system were sampled.
The analytical data indicate that all the parameters are in compliance with Groundwater Quality
Standards and the construction of the subject well is in compliance with the permit conditions. If you
have any questions, please contact me at [phone].
1 :: •FIV14.�aim
The Central Office-APS Piles
Aquifer Protection Section
1628 MaiI 5ery ice Center. Raleigh, North Carol ina27699-1628
Location: 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone. [phone] \ FAX: [phone]
Internet www.ncwateMuality.org
An Equal Opportunity 1 Affirmative Action Employer
Sincerely,
te�M CLA7
Lin McCartney
Environmental Senior Tech
REGEIVEDIDENRIM
MAR 12 2 013
Aq1> 9rProtecWn SectiDn
Na thCarolina
Aahmally

N(' (DWO Labardtory .�ectian hesutts
County: ORANGE
Vyg7�
Sample ID:
A890878
River Basin
H OF
ti OG
PO Number*
12GIO74
Report To RROAP
r�
1 r
Date Received:
1211212012
Time Received:
11:05
Collector. L MCCARTNES
flY
-�
Labworks LoginlD
HMQRGAN
Region: RRQ
Final Report Date:
1128113
Sample Matr#x: GROUNDWATER
Final Report
Report Print pats:
03l0112013
Lac. Type: WATER SUPPLY
Emergency Yes/No
VisivD
CDC YeslNo
Loc. Descr.: WILLIAM DYSON 2100 DIMMOCKS MILL RD
Location ID SP068WID600181.IN
Collect Date: 1211212012 Collect Time: 10:00
Sample Depth
If this report is labeled preliminary
report, the results have not been validated.
Do not use for Regulatory purposes.
CAS #
LAB
Anaiyte Name
Sample temperature at receipt by lab
PQL
Result!
Qualifier
3.9
Units
zC
Method
reference
Anal
Date
12/12/1
Validated by
HMORGAN
MIC
Coiiform, MF Fecal in liquid
1
1 B2
CFLI1100ml
APHA9222D-20th
1211V1
ESTAFFORDI
Coliform, MF Total in liquid
1
1 B2
CFi11100ml
APHA9222B-20th
12112/1
ESTAFFORDI
WET
Ion Chromatography
TITLE_
mglL
EPA 300.0
12/18/1
MOVEPMAN
Chloride
0.5
2.9
mg1L
EPA 300.0
12/18/1
MOVERMAN
Fluoride
0.2
0.9
mg1L
EPA 300.0
1211811
MOVERMAN
Sulfate
1.0
200
mg]L
EPA 300.0
1211811
MOVERMAN
Total Dissolved Solids in liquid
12
390
mg/L
APHA254OC-18TH
1211811
MOVERMAN
NUT
NO2+NO3 as N in liquid
0.02
0.02 U
mgfL as N
LaclO-107.04-1t
12/1411
CGREEN
MET
7429.90-5
Al by ICP
50
50 U
uglL
EPA 200.7
12114/1
ESTAFFORDI
7440-70.2
Ca by ICP
0.10
100
mglL
EPA 20D.7
12117/1
ESTAFFORDI
7440-47.3
Cr by ICPMS
10
IOU
ug&
EPA 200.8
113113
ESTAFFORDI
7440-60-8
Cu by ICPMS
2,0
5.7
ug1L
EPA 200.8
12I1711
ESTAFFORD1
7439-89-6
Fe by ICP
50
s0 U
uglL
EPA 200.7
1211411
ESTAFFORDI
7440-09-7
K by ICP
0.10
0,55
mglL
EPA 200.7
12117/1
ESTAFFORDI
7439-95-4
Mg by ICP
0.10
2.0
mg1L
EPA 200.7
12/1711
ESTAFFORD1
7439.96-5
Mn by 1CP
10
12
ug/L
EPA 200.7
1211411
ESTAFFORDI
7440-23-5
Na by 1CP
0.10
29
mg1L
EPA 200.7
1211711
ESTAFFOR01
7440-02-0
Ni by furnace
2,0
2.0 U
uglL
EPA 200.9
1212011
ESTAFFORDI
7439-92-1
Pb by ICPMS
2.0
2.0 U
uglL
EPA 200.8
1211711
ESTAFFORDI
7440-66-6
Zn by ICPMS
10
330
uglL
EPA 200.8
12/1711
ESTAFFORDI
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Fora rfntadad de 5QjP40F1 of the gUal,11W codas aroe to ntto.11n7[iYl.nrdenf.arGlwrS/w7Llabl�lahi AlolMih3yy]y{�16itV Qu3il}4r1 CGdN rhStn.�faq�.Z1.ncdenr.� �(W-yWwoflahlstaTHniaRechasIL&
Page 1 of 1

% qy~ £a6orato esufts
County: ORANGE of WAi~-9 Sample ID: AB90879
River Basin 9c. PO Number# 12G1075
Report To ~ 5(! r; Date Received: 12/12/2012
2: =i Time Received: 11:05
Collector: LMCCARTNEY 0 -<
Region : RRO
Labworks LoginlD HMORGAN
Sample Matrix: GROUNDWATER
Final Report Date: 1/28/13
Loe. Type : WATER SUPPLY Final Re (2 ort Report Print Date: 03/01/2013
Emergency Yes/No VisitlD
COC Yes/No
Loe. Descr.: WILLIAM DYSON 2100 DIMMOCKS MILL RD
Location ID: 5P068WI0500181-EFF Collect Date : 12/12/2012 Collect Time : 10:30 Sample Depth
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS# Analyte Name PQL ResulU Units Method Analysis Validated bv Qualifier Reference Date
LAB
Sample temperature at receipt by lab 3.9 ·c 12/12/1 HMORGAN
MIC
Coliform , MF Fecal in liquid 1 1 82 CFU/100ml APHA9222D-20th 12/12/1 ESTAFFORD1
Coliform, MF Total in liquid 1 1 B2 CFU/100ml APHA92228-20th 12/12/1 ESTAFFORD1
WET
Ion Chromatography _TITLE mg/L EPA 300.0 12/18/1 MOVERMAN -
Chloride 0.5 3.0 mg/L EPA300.0 12/18/1 MOVERMAN
Fluoride 0.2 0.9 mg/L EPA300.0 12/18/1 MOVERMAN
Sulfate 1.0 200 mg/L EPA 300.0 12/18/1 MOVERMAN
Total Dissolved Solids in liquid 12 409 mg/L APHA2540C-18TH 12/18/1 MOVERMAN
NUT
N02+N03 as N in liquid 0.02 0.02 U mg/Las N Lac10-107-04-1-c 12/14/1 CGREEN
MET
7429-90-5 Al by ICP 50 · 50 U ug/L EPA 200.7 12/14/1 ESTAFFORD1
7440-70-2 Ca by I_CP 0.10 100 mg/L EPA200.7 12/17/1 ESTAFFORD1
"
7440-47-3 Crby ICPMS 10 10 U ug/L EPA200.8 1/3/13 ESTAFFORD1
7440-50-8 Cu by ICPMS 2.0 7.8 ug/L EPA200.8 12/17/1 ESTAFFORD1
7439-89-6 Fe by ICP 50 sou ug/L EPA200.7 12/14/1 ESTAFFORD1
7440-09-7 K by ICP 0.10 0.56 mg/L EPA200.7 12/17/1 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 2.0 mg/L EPA200.7 12/17/1 ESTAFFORD1
7439-96-5 Mn by ICP 10 11 ug/L EPA200.7 12/14/1 ESTAFFORD1
7440-23-5 Na by ICP 0.10 28 mg/L EPA200.7 12/17/1 ESTAFFORD1
7440-02-0 Ni by furnace 2.0 2.0 U ug/L EPA 200.9 12/20/1 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA 200.8 12/17/1 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 400 ug/L EPA200.8 12/17/1 ESTAFFORD1
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description of the qualifier codes refer to bttp·/Jport;Ln«lenr.orc/web/wanab/Hiftlnfo/techitlist#Pttil Qualifier Codes <http;f/portfi,ncdenr,oe&tt,eb/wq/!ab/stafflnfo/techaHISb
Page 1 of 1
•r
Permit Number WI0500181
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
eric.g .smith
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
William and Persis Dyson
Location Address
2100 Dimmocks Mill Rd
Hillsborough
Owner
Owner Name
William
Dates/Events
NC 27278
Dyson
Scheduled
Orig Issue
04/11/08
App Received Draft Initiated Issuance
11/13/12
Regulated Activities
Heat Pump Injection
Outfall NULL
Central Files : APS _ SWP_
01/15/13
Permit Tracking Slip
Status
Active
Project Type
Renewal
Version
2.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
William Dyson
2100 Dimmocks MIii Rd
Hillsborough NC
Public Notice Issue
11/19/12
Effective
11/19/12
Reguested/Rece ived Events
RO staff report requested
RO staff report received
27278
Expiration
11/30/17
11/19/12
12/18/12
Waterbody Name Stream Index Number Current Class Subbasin
Permit Number W10500181
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
eric.g.smith
Coastal SW Rule
Permitted Flow
Central files: AP5 SWP
12119/12
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Facility
Facility Name MajorlMinor Region
William and Persis Dyson Minor Raleigh
Location Address County
2100 ❑immocks Mill Rd Orange
Hiilsborough NC 27278 Facility Contact Affiliation
Owner Name Owner Type
Individual
William Dyson Owner Affiliation
William Dyson
1022 Jefferson Rd
DateslEvents Greensboro NC 27410
Scheduled
Orig Issue App Received Draft Initiated Issuance public Notice Is Effective Ex ianl
04/11/08 11/13/12
Regulated Activities Re uestec!lReceiveri Events
Heat Pump Injeclion RO staff report requested 11/19/12
R7 staff report received 1211$112
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

MA
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
William and Persis Dyson
2100 Dimmocks Mill Road
Hillsborough, NC 27278
Re: Issuance oflnjection Well Permit
Permit No. WI0500181
Issued to William and Persis Dyson
Nash County
Dear Mr. and Mrs. Dyson:
. Charles Wakild, P.E.
Director
November 19, 2012
Dee Freeman
Secretary
In accordance with your application received November 13, 2012, I am forwarding Permit No. WI0500181 for the
operation of a geothermal heating/cooling return well heat pump system located at the above referenced address. This
permit shall be effective from the date of issuance until November 30, 2017, and shall be subject to the conditions and
limitations stated therein.
The Raleigh Regional Office collected groundwater samples from your geothermal system on December 12, 2012. After
the laboratory analytical results are received, the results will be forwarded to you by the regional office.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application to renew
the permit 120 days prior to its expiration date. As indicated in the permit, this permit is not transferable to any person .
without prior notice to, and approval by, the• Director of the Division of Water Quality. If you have any questions
regarding your permit or tlie Underground Inje.ction Control Program please call me at [phone] .
Best Regards,
C,_ ,l}. fa,~
Eric G. Smith, P.G.
Hydro geologist
cc: Raleigh Regional Office, Aquifer Protection Section
Central Office File, WI050018 l
Oran e Coun Environmental Health Dept. --~-·--------------
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone : [phone] I FAX : [phone]
Internet: www .ncwaterquality .org
An Equal Opportunity I Affirmative Action Employer
No1!S..._c Ii 01u1 aro na
:Vatural/11
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLOA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR IN.iECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HERESY GRANTED TO
WILLIAM AND PERSIS DYSON
FOR THE OPERATION OF A GEOTHERMAL HEATINGICOOLINCr WATER RETURN WELL, defined in
Title 15A North Carolina Administrative Code 2C .0224, which will be used for the injection of heat pump
effluent. This injection well is located at 2100 Dimmocks Mill Road, Hillsborough, Orange County, NC 27278,
and will be constructed and operated in accordance with the application received November 13, 2012, and in
conformity with the specifications and supporting data received December 18, 2012, all of which are filed with
the Department of Environment and Natural Resources and are considered a part of this permit.
This permit is for operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until November 30, 2017, and shall
be subject to the specified conditions and limitations set forth in Parts I through V11I hereof.
Permit issued this the - day of , 2012.
D&� )-,Ujk
Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #WI0500181 UIC/Return Well Page 1 of 5
ver. 07/2012

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be sealed with a water-tight cap or well sealed, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.01070).
PART II-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degradingnfwzteLquality_of the.aquifer_ _______________________________________ _
PART III-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
Permit #WI0500181 UIC/Return Well
ver. 07 /2012
Page 2 of 5
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate .corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV -OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions .in the permitted facility or activity not specifically authorized by
the permit.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VI -MONITORING AND REPORTING REQUIREMENTS
2.
Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Ralcigh_R.egwnal Office. telephone number 919-791-4200, any of the followinO-':~--
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
Permit #WI0S00181 UIC/Return Well
ver. 07 /2012
Page 3 of 5
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII -PERMIT RENEW AL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
PART VIII-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0240 ,
Abandonment and Change-of-Status of Wells.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0240, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed the _casing shall be perforat~Q:~C>Qg~ite the gr~~1.J>~~L_~1j!!tervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
Permit #WI0500181 UIC/Return Well
ver. 07/2012
Page 4of s
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(±)(4) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Permit #WI0500181
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC/Return Well
ver. 07 /2012
Page 5 of 5
A.VA
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Quality
Charles Wakild, P. E
Director
December 12, 2012
MEMORANDUM
To:
Through:
From:
Michael Rogers, The Central Office, APS
Jay Zimmerman <;_(Zf-, i ,52_
Lin McCartney
Subject: Staff Report-WI0500181, William Dyson, Open-Loop
Geothermal Injection Well, Well Renewal Application
Orange County
Aquifer Protection Section
RECEt\lED/DENR/DWQ
DEC 1 8 2012
Aquifer Protection Section
Dee Freeman
Secretary
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone: [phone] \ FAX: [phone]
Internet: www.ncwaterguality.org
An Equal Opportunity\ Affirmative Action Employer
Nirth Carolina
Jvatural/11
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: December 12, 2012
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ _
L GENERAL INFORMATION
County: Orange
Permittee: William Dyson
Project Name: Open-Loop Geothermal
Injection Well
Application No.: WI0S00181
1. This application is (check all that apply): D New IZI Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
0 Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation IZI Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? rgJ Yes or D No.
a. Date of site visit: 12-12-2012
b. Person contacted and contact information: William Dyson. 919-732-7578, 33 6-549-6184
c. Site visit conducted by: Lin McCartney
d. Inspection Report Attached: IZI Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
IZI Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For Disposal and Iniection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site. or attach additional pages for each site)
a. Location(s): 2100 Dimmocks Mill Rd., Hillsboroum. NC 27278
b. Driving Directions: Hwy I-40 W for 27.5 miles. take Exit 261. tum right onto Old NC-86, tum left onto
Oakdale Dr .. turn left onto Orange Grove Rd .. take ist right onto New Grady Brown School Rd., turn left
onto Dimmocks Mill Rd.
c. USGS Quadrangle Map name and number:
d. Latitude: 36-02-49 Longitude: 79-08-18
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
FORM: Staff.Report-Dyson
RECEIVED/DENR/DWQ
DEC 1 8 2012
Aquifer Protection Section
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities -New, Renewal , And Modification
1. Type of injection system:
[8J Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
□ In situ remediation (5I)
D Closed-loop groundwater remediation effluent injection (SL/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? [8J Yes
3. Are there any potential pollution sources that may affect injection? [8J Yes
ONo
□No
What is/are the pollution source(s)? The septic tank. The septic tank is approximately 100 feet distance from
the well.
4. What is the minimum distance of proposed injection wells from the property boundary? 40ft.
5. Quality of drainage at site: [8J Good D Adequate D Poor
6. Flooding potential of site: [8J Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program : NI A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [8J Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal And Modification Onlv :
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes [8J No. If yes , explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No . If v es . explain:
3. For renewal or modification of g roundwater remediation permits ( of an type ). will
continued/additional/modified in jections have an adverse impact on mie ration of the plume or management of
the contamination incident? D Yes D No. If yes . explain:
FORM: StaffReport-Dyson 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
4. Drilling contractor: Name: Hudson Well.
Address:
Certification number: 2072
5. Complete and attach Well Construction Data Sheet.
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes i:gJ No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
FORM: Staff.Report-Dyson 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
7 . Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information; [gl
Issue; D Deny. If deny, please state reasons: __
-P . n-1 C/' ·/· ~ 8. Signature ofreport preparer(s): (/' > 11 ~ Le,..,{ VI u{) ~
Signature of APS regional supervisor: £; .J?_;_ ~ 2 ~ ~
Date: /3/°/'z.__
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
Well water sampling was conducted on December 12, 2012.
By looking at the outward condition of the well (wellhead, well ID Plate, concrete base, and two
spigots), it appeared to be in compliance with N.C. State Regulations (Title 15A NCAC 2C), Well
Construction Standards.
Over all, this geothermal injection well is in compliance with well construction standards.
However, we are awaiting the lab results of the well water to complete this application process.
FORM: Staff.Report-Dyson 6
,.
Compliance Inspection Report
Permit: WI0500181
SOC:
Effective: 04/11/08 Expiration: 03/31/13 Owner: William Dyson
Effective: Expiration: Facility: William and Persis Dyson
County: Orange
Region: Raleigh
Contact Person: William Dyson
Directions to Facility:
Title:
2100 Dimmocks Mill Rd
Hillsborough NC 27278
Phone:
Hwy 40 to Old NC 86 South, turn right on Davis Rd., turn right on Orange Grove Rd., turn left on Dimmocks Mill Rd., about .5 miles on
the rii:iht.
Syste-m Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 12/12/2012
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Entry Time: 10:00 AM
Certification:
Exit Time: 11 :00 AM
Phone:
Phone: [phone]
Ext.4243
Reason for Inspection: Routine Inspection Type: Compliance Sampling
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500181
Inspection Date: 12/12/2012
Inspection Summary:
Owner -Facility: William Dyson
Inspection Type: Compliance Sampling
Well water sampling was conducted on December 12, 2012.
Reason for Visit: Routine
By looking at the outward condition of the well ( well head, well ID Plate , concrete base, and two spigots), it appeared to
be in compliance with N.C. State Regulations (Title 15A NCAC 2C), Well Construction Standards.
Over all, this geothermal injection well is in compliance with well construction standards.
However, we are awaiting the lab results of the well water to complete this application process.
Page: 2
ti
�'
Application Reviewer:: PC
Pre -Review: Conducted? Z," es ❑ No
O.K. to Process? Yes ❑ No
Jf No, What Action Is Needed.? ❑ Pre -Review Return
❑ Hold, Pending Receipt of Addinfo.: Y
Name/Affiliation of Person Contacted:
Owner: LxWing D Unlaamvn Owner Type Non -Gov't ( nci. or ❑ Org)
FacilitvlOneration: ❑ Proposed "E Sting
Regulated Activities:
AM ication/Permit:
Permit 'Type:
❑ Injection Water Wy GSHP Well System (5QW)
❑ Injection Mixed Fluid GSHP Well System (5 QM)
❑ Injection Tracer Well (M
Project Type. ❑ New ❑ Major Mod.
Notes:
❑ Gov. -County ❑ Gov. -State
kv�41 i:?,-
❑ �xov,-Municipal
❑ Gov. Fedezal
❑ Facility ❑ Operation
❑ Injection In situ Groundwater Remediation Well (51)
�njection HeatinglCoohng Water Return Well (5A7)
Injection Other Walls (5Z)
U i„ju�u�ii� Agwter lzcchnrgc (S�i`L1)
❑ Minor Mod. Renewal ❑ Renewal wl Mod.
FORM: RIMS 10/04/2007

Permit Number WI0500181
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
William and Persis Dyson
Location Address
2100 Dimmocks Mill Rd
Hillsbuough NC 27278
Owner
Central Files; APS SWP
11116/12
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Raleigh
Cou my
Orange
Facility Contact Affiliation
Owner Name Owner Type
Individual
William Dyson Owner Affiliation
William Dyson
1022 Jefferson Rd
Greensboro
Dates/Events
Scheduled
❑rig Issue App Received Draft Initiated Issuance Public Notice Issue
04/11/08 11/13/12
Regulated Activities
Heat Pump Injection
Outfall NULL
Waterbody Name
Stream Index Number
NC 27410
Effective Expiration
Current Class Subbasin

ALIT
HCDENk
Wit Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Waki#d, P.E.
Qavemor Director
November 16, 2012
William Lee Dyson -
Persis Mercer Dyson
2100 Dimmocks Mill Road
Hillsborough, NC 27278
Dear Mr. and Mrs. Dyson:
Natural Resources
Dee Freeman
Secretary
Subject, Acknowledgement of
Application No. WI0500181
William and Persis Dyson
Injection HeadDg/Cooting
Water Return Well System
Orange County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on November 13, 2012. Your application package has been assigned the number
listed above, and the primary reviewer is Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
s inceraly, j
for ❑ebra7. Wa
Groundwater Protection Unit Supervisor
CC'. Raleigh Regional Office, Aquifer Protection Section
Permit File Wf0500181
AQUIFER PROTECTION GeCTION
1636 Mail Senrice Center, Raleigh, North Carolina 27699-1616
location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] FAX: 919-607jW6
Intemet: www.nmatotgo lftv.erg
One:.
N rthCarolina
An Equal OpportunglAtt<rmobve Action Employer

Pr
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 62C .0200
OPEN -LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) New Application Renewal* Modification
* For renewals complete Parts A-C and the signature page.
lnt or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: 0 a,: 2� !
PERMIT NO. 44ff (leave flank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence Business/Organization
Government: State Municipal County Federal
B. PERMIT APPLICANT — For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
Mailing Address: 2,104 PfWw��s .'wIZ Ab
City_ H1f4.5��00,914 State: A-)C Zip Code: 27274f County: 6"-VK
Day Tele No.: i 73Z ^757-8 Cell No.:
EMAIL Address: /7e Fax No.:
C. LOCATION OF WELL SITE — Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: 5)e...;Q 96 5f-- County: eM44'r dE7
(2) Physical Address (if different than mailing address); "!c, azee6rn& aAo
City: State: NC Zip Code:
RECEIVEDIDENRIM
D. WELL DRILLER INFORMATION 1110,111 13 20 P
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.: F����6� QiOt
Company Name:
Contact Person: EMAIL Address:
Address:
City:
Office Tele No.:
Zip Code:
GPUMC 5A7 Permit Application (Revised 3/18/2011)
Cell No.:
State: County:
Fax No.
Page 1

E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
F.
Company Name: ________________________________ _
Contact Person~: ________________ E_MA __ IL_A~d~d_re~s~s~: ___________ _
Address:------------------------------------
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: __________ .a..Fa=x.a...a...N=o=·=--------
WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ----
YES ___ _
NO ----
NO ___ _
G. WELL CONSTRUCTION DATA
(1)
____ PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(6) below as PROPOSED construction specifications. Submit Form GW-1 after construction.
____ EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
Well Construction Date: ________ Number of borings: ___ _
Depth of each boring (feet): _______ _
(2) Well casing type: Galvanized steel __ Black steel __ Plastic __ Other (specify) _____ _
(3)
(4)
(5)
Casing thickness (in.): __ Diameter (in.): __ _
Well depth: from: ___ to: ___ feet below land surface
Casing extends above ground ____ inches
Grout material surrounding well casing:
(a) Grout type: Cement__ Bentonite* Other (specify) ______ _
*By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .02l3(d)(l)(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from ___ to ___ feet
Well Screen or Open Borehole depth (relative to land surface): from ____ to ____ feet
N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make prov1s1ons for
monitoring wellhead processes. A faucet ori both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Is there a faucet on:
(a) Influent line? Yes No (b) Effluent line? Yes No
(6) Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-1 is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? ( e.g.
granite, limestone, sand, etc.)
Depth: _______ Formation: ______ Rock/sediment unit: _______ _
NOTE: THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
GPU/UIC 5A 7 Permit Application (Revised 3/18/2011) Page2
H. OPERATING DATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
·Injection Temperature:
Average (daily) __ ~gallons per minute (gpm).
Average (daily) gallons per day (gpd).
Average (daily) pounds/square inch (psi).
Average (January)-° F, Average (July)_·_·_·° F.
I. WELL LOCATIONS -Maps must be scaled or otherwise accurately indicate .distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearl y and include a north arrow.
(1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location.of the wells in relq,tion to property boundaries~ houses; septic tanks, other
wells, etc. can then be dr«:wn in by hand. Also., q 'layer' can be selected showing (opographic contours or
elevation data. · ·' ·
GPU/UIC 5A7 Permit Application (Revised 3/18/2011) Page3
J. CERTFFii CATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(b) requires that all permit applications shall be signed as follows_
I . for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship; by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others; by the well owner [which means all persons listed on the propert. deed}.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete_ I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
Signature of Property Owner/ApplicanK
Print or Type Full Name
Signature of Property Owner/Applicant
A�6,9 _]tom -144 A QEA D Ysa-V-
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to,
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVFaf0FNRIDWQ
NOV
Aq uilLor proteajail SeC11orJ
Gi U/UIC 5A7 Permit Application (Revised 3/18/201I) Page 4

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: &1E ®5-®elf /d?l
Permittee Name:
Address:�a4
Please check the selection which most closely describes the current status of your injection well system:
1) X Well(s) still used for injection activities, or may be in the future.
2) L l Well(s) not used for injection but is/are used for water supply or other purposes.
3) ❑ Injection -discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) C Injection well(s) never constructed
2
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
Well Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description ofhow the well
was seated and the type of material used ro fill the well if permanently abandoned):
Permit Rescission:
Yyou checked (2), (3), or (4) and will not use a well for injection on this site ir.'d:z futurc, ycu should request rescission of the
permit. Do you wish to rescind the pen -nit?
❑ Yes ❑ No
Certification:
"I hereby certify, under penalty of law, ttrat I have personally examined and am farrriliar with the information submitted
in this document, and that to the best of my knowledge the information is true, accurate, and complete."
Signature Date
RECEIVEDIDENRIDWQ
Revised 5/05 GWIUIC-68 ggoffer Profecb0 2 Secuon

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
OPEN -LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) New Application Renewal* Modification
* For renewals complete Parts A-C and the signature page.
Print or Type Information and Mail to the Address on the Lust Page. Illegible Applications Will Be Relurned Aj Incomplete.
DATE: ^ 1,4 &� 10' , 20 !�
PERMIT NO. 6VZ 451617 IB / (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence D Business/Organization
Government: State Municipal County Federal
B. PERMIT APPLICANT - For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
Mailing Address: A,D - —
City: -<5 Gl� State. A-Je Zip Code: 2727e County: C�4A�2
Day Tele No.: 9 — Z - 75�,9 Cell No.: 3 - •� �� - ��4
EMAIL Address: E.eJ "Ley' Fax No.:
..ems
C. LOCATION OF WELL SITE - Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: County:
(2) Physical Address (i£ different than mailing address): —__-3ac4Ae G S u��r, r, �F4dT��6 ai�E r "
City:
D. WELL DRILLER INFORMATION
State: NC Zip Code: __
RECEIVEDMENRIM
Well Drilling Contractor's Name:
SOY 13 2012
NC Well Drilling Contractor Certification No..
Company Name:
Contact Person: EMAIL Address:
Address:
City: _ _
Office Tele No_:
Zip Code: _ State:
Cell No.:
County:
Fax No.
GPUlUIC 5A7 Permit Application (Revised 3/18/201 i) Page t

E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: ________________________________ _
Contact Person.,_: _______________ E=MA~I=L'-'A~dd=r=e=ss=: ___________ _
Address: __________________________________ _
City: _________ Zip Code: ____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ----------=-=-=-~=---------
F. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES ____ NO ___ _
(2) Personal consumption? YES ____ NO ___ _
G. WELL CONSTRUCTION DATA
(1)
PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through ----
(6) below as PROPOSED construction specifications. Submit Form GW-1 after construction.
____ EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available .
Well Construction Date: ________ Number of borings: ___ _
Depth of each boring (feet): _______ _
(2) Well casing type: Galvanized steel_·_ Black steel __ ._ Plastic __ Other (specify) _____ _
(3)
(4)
(5)
(6)
Casing thickness (in.):_·_·_ Diameter (in.): __ _
Well depth: from: ___ to: ___ feet below land surface
Casing extends above ground ____ inches
Grout material surrounding well casing:
(a) Grout type: Cement__ Bentonite* Other (specify) ______ _
*By selecting bentonite grout, a variance is hereby requested to 15A NCAC 2C .0213(d)(l)(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from ___ to ___ feet
Well Screen or Open Borehole depth (relative to land surface): from ____ to ____ feet
N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead processes. A faucet ori both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Is there a faucet on:
(a) Influent line?. Yes __ No (b) Effluent line? Yes No
Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-1 is not available , provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite, limestone, sand, etc.)
Depth: _______ Formation: ______ Rock/sediment unit: _______ _
NOTE: THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
GPU/UIC SA 7 Permit Application (Revised 3/18/20 t t) Page2
·-
H. OPERATING DATA
(l)
injection Rate:
(2)
Injection Volume:
(3)
Injection Pressure,
(4)
Injection Temperature:
Average (daily) gallons per minute (gpm).
Average (daily) gallons per day (gpd).
Average (daily) pounds/square inch (psi),
Average (January) ° F, Average (July) ° F.
I. WELL LOCATIONS -- Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clean} and include a north arrow.
(1) Attach a site -specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 114 mile from the injection well site that indicates the
facility's Iocation and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can he
obtained and downloaded from the applicable county GIS website Typically, the property can be searched by
owner name or address, The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a `layer' can be selected showing topographic contours or
elevation daft
C,PUIUIC 5A7 Permit Application (itevised 3/18/2011) Page 3

J. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C _0211(b) requires that all permit applications shall be sighed as follows:
I . for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3_ for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which [Weans all persons listed on the e property deed),
If an authorized agent is signing ou behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and atn familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
Signature of Property Owner/Applicaae
GEC -DY--,d64J
Print or Type Full Name
Aj'� e)�tj ,
Signature of Property Owner/Applicant
Print or Type Full Name
;e
Signature of Authorized Agent, if any
Print or Type Full Name
Subunit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECE[VEDIDENROW0
Nov 13 201Z
AquIfef Prow com Sedon
GPII/MC 5A7 Permit Application (Revised 3/lW0I t)
Aw,•s.opna�
Page 4

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: mil-' e�6961 /W %
Permittee Name: C.tJ!! l.�c t C . IjYs©t
Address: ive �ir ss•t DCrr S �'C � . j�rGcs�3c+�d u� l,J l C
Please check the selection which most closely describes the current status of your injection well system:
1) x Well(s) still used for injection activities, or may be in the future.
2) ❑ Well(s) not used for injection but Ware used for water supply or other purposes.
3) ❑ Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) ❑ Injection well(s) never constructed
N
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
Well Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description ofhow the well
was sealed and the type of material used tofill ill the well if permanently abandoned):
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in th.: future, you should request rescission of the
permit. Do you wish to rescind the permit?
❑ Yes ❑ No
Certification:
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted
in this document, and that to the best of my knowledge the information is true, accurate, and complete."
Signature Date
RECEIVEDICENRIDyVQ RECESVECICENRIDWa
truly 13 ?aIr
Revised 5/05 GWIUIC-68 N
Aqu fer Prot000n sawon Aquifer Protection Won

Smith, Eric
From: Rice, Eric
Sent:
To:
Tuesday, December 04, 2012 11 :05 AM
Smith, Eric
Subject: RE: Staff Report for Geothermal Permit WI0500181 (Dyson)
Eric;
Yes. Looks like this is a renewal. Lin McCartney will be completing an inspection on this
one. I think there are water well samples collected on renewals.
ER
Email correspondence to and from this address may be subject to the North Carolina Public
Records law and may be disclosed to third parties
-----Original Message-----
From: Smith, Eric
Sent: Tuesday, December 04, 2012 9:24 AM
To: Rice, Eric
Subject: FW: Staff Report for Geothermal Permit WI0500181 (Dyson)
Eric:
Did you want to do the inspection?
-Eric
Eric G. Smith, P.G.
Hydrogeologist
NCDENR
Division of Water Quality
Aquifer Protection Section
Groundwater Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Phone: [phone]
Fax: [phone]
Website: http://portal.ncdenr.org/web/wg/aps
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are
subject to the North Carolina Public Records Law and may be disclosed to third parties.
-----Original Message-----
From: Smith, Eric
Sent: Monday, November 19, 2012 1:27 PM
To: Rice, Eric
Subject: Staff Report for Geothermal Permit WI0500181 (Dyson)
Eric:
1
Please find the attached open-loop geothermal permit. Do you want to perform a pre-
permitting inspection?
-Eric G. Smith
Eric G. Smith, P.G.
Hydrogeologist
NCDENR
Division of Water Quality
Aquifer Protection Section
Groundwater Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Phone: [phone]
Fax: [phone]
Website: http://portal.ncdenr.org/web/wg/aps
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are
subject to the North Carolina Public Records Law and may be disclosed to third parties.
-----Original Message-----
From: Eric G. Smith [mailto:eric.g [e-mail]]
Sent: Friday, November 16, 2012 4:02 PM
To: Smith, Eric
Subject:
This E-mail was sent from "RNPAC7DD0" (Aficio 2075).
Scan Date: 11.16.2012 16:02:06 (-0500)
Queries to: robin.markha m@)ncdenr.gov
2
North Carolina
Beverly Eaves Perdue
Governor
William Dyson
2100 Din mocks Mill Road
Hillsborough, NC 27278
ATiZA..
NCDENR
Department of Environment and Natural Resources
Division of Water Quality
Charles Wakiid, P. E. Dee Freeman
Director Secretary
November 2, 2012
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. WI0500181
Orange County
Dear Mr. Dyson:
The Underground Injection Control (L.IIC) Program of the North Carolina Division of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for
the underground injection well system located on your property at 2100 Dimmocks Mill Road in
Hillsborough, NC, which was issued to you on April 11, 2008, and expires on March 31, 2013, is
soon due for renewal. - If you wish to keep this permit and operate the injection well system, the
permit must be renewed and issued in your name.
If Your Injection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted.. The GW-30 and Name/Ownership
Change farms can be found at lntt �://�ortal.ncdellr.pm/welt/wg/alas/gw ro/renarting-farms.
If Your Injection Well is Currently Active:
If the injection well System is still active and you wish to renew your permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by November 30, 2012.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Ralei h, Norltr Carolina 27699-1636 One
Location: 512 N. Salisbury St., Raleigh. North Carolina 27604 NorthCarollrla
ww.n Phone: 91 46e 1 FAX 919�07-6A96
Intemel: a e uality.oro
An Equal ❑ppoftky 1 Affirnia0ve Action Ern;aM r

In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct andlor Use a Wells) for Injection with
Geothermal Heat Pump System for Type 5A7 Well(s) if the injection well system on your
property is still active.
M
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http :Ilp ortal . ne denr. orLlweb/wg/apsl�-, w n ro/pem-iit-a1., p 1 i cations# L, e o therm App s.
Thank you in advance for your cooperation and timely response, If you have any questions,
please contact me by phone at [phone] or by email at cric.t,.smith(@,ncdenr.gov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Raleigh Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10500181 w/o enclosures

Permit Number W10500981
Program Category
Ground Water
Permit Type
Injection HeatinglCooling Water Return Well (5A7)
Primary Reviewer
michael.ragers
Permitted Flow
Central Files: AP5 SWP
04111 /08
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Facilit
Facility Name MajoriMinor Region
William and Persis Dyson Minor Raleigh
Location Address County
2100 Dimmocks Mill Rd Orange
Hillsborough NC 27278 Facility Contact Affiliation
fggItar
Owner Name Owner Type
Individual
William Dyson Owner Affiliation
William Dyson
1022 Jefferson Rd
Greensboro NG 27410
Dat
Scheduled
Crig Issue App Received Craft Initiated Issuance Public Notice Issue Effective Expiration
02126f08 (I 101 3l a l I OiLin
Reoulated Activities I f r,; rd Fv rat
Heat Pump Injection RO staff report requested 03/18/08
Rt7 staff report received 04108/08
Outfail NULL
Waterbody Name Stream Index Number Current Class Subbasin

Michael F. Easley, Govemor
WilEam G. )toss Jr., Secretary
Nc)rth Carolina Dop:artmont of Environment and Natural Resources
Coleen H. 5tillins, Director
Division of Water Quality
April 11, 2008
William and Persis Dyson
1022 Jefferson Road
Greensboro, NC 27410
Re: Issuance of Injection Well Permit
Permit No. WI0500181
Issued to William and Persis Dyson
Dear Mx. and Mrs. Dyson:
In accordance with your signed application received February 26, 2008, 1 am forwarding Permit
No. WI0500181 for the operation of a 5A7 geothermal underground injection well (LUC) Feat
pump system located at 2100 Dimmocks Mill )toad, Hillsborough, Orange County, North
Carolina. This permit shall be effective from the date of issuance until March. 31, 2013, and shall
be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in permit conditions in Part I,
paragraphs 7 and 8. Copies of the GW-1 well completion form(s) shall be retained on -site
for inspection. Also, a well ID plate must be affixed to the geothermal system. Your heat
pump and well contractors should provide this information. Please retain these records so
that in the event your property is sold or transferred, the new Permittee will have this
information.
Also, please notify the Raleigh Regional Office at 919-791-4200 when the geothermal
system is operational in order for groundwater samples to be collected from the influent
and effluent sampling spigots.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit four (4) months prior to its expiration date. As indicated in
the permit, this permit is not transferable to any person without prior notice to, and approval by,
the Director of the Division of Water Quality.
If you have any questions regarding your permit or the Underground Injection Control (U1C)
Program please call Mr. Qu Qi at [phone] or me at [phone].
Nix` Carolina
NaturallY
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone' (919) 733-322I
intemet: hun:llwww.ncwatemLLality_clr 2728 Capital Boulevard Raleigh, NC 27604 Fax 1' [phone]
Fax 2: (.919) 715-6049
An Equal Qpportuni ylAff rmarive Anton Employer— 50°% Recy6eNl0% Post Consumer Paper Customer Smice [phone]

Best Regards, 12;
/~ ~
/
Michael Rogers
Environmental Specialist
GPU -UIC Control Program
cc: Jay Zimmerman -Raleigh Regional Office
Central Office File -WI0500181
Orange County Health Department
Attachment( s)
WI0500181 Page2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other
applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
WILLIAM AND PERSIS DYSON
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This injection well is located at 2100 Dimmocks Mill Road, Hillsborough,
Orange County, North Carolina, and will be operated in accordance with the application received
February 26, 2008, and in conformity with the specifications and supporting data submitted, all
of which are filed with the Department of Environment and Natural Resources and are
considered a part of this permit.
This permit is for Operation only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall
be in compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and
any other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until March 31, 2013,
and shall be subject to the specified conditions and limitations set forth in Parts I through Vill
hereof.
~
Permit issued this the ---1--~--day of_~~-0_· ___ , 2008.
~ )~~-
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0500181 Page3
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each geothermal well injection system shall have permanently affixed an
identification plate according to 2C .0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to, DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff, 1636
Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction. Copies of the GW-1 well completion form(s) shall be retained on-site
and available for inspection.
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
WI0500181 Page4
imposed by other local, state, and federal agencies, which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART III-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
WI0500181 Pages
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Raleigh Regional Office, telephone number (919) 791-
4200, any of the following:
(A) Any occurrence at the injection facility , which results in any unusual
operating circumstances;
(B) Any failure due to known or unknown reasons, that renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
PART VII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinuation of use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
WI0500181 Page 6
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement'grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion
of abandonment. ·
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
WI0500181
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 7
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 04/02/2008 County: Orange
To: Attuifer Protection Section Central Office Permittee: William and Persis Dyson
Central Office Reviewer: Michael Ropers Project Name: UIC- OA71 Open Loop
Regional Login No: 05 Application No.: W10500181
L GENERAL INFORMATION
1. This application is (check kit that appiy): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment S included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 04/02/2008 RECBVED 1 DENR 10VVQ
b. Person contacted and contact information: William Dyson, Phone# [phone] Aquifer Protection Section
c. Site visit conducted by: Ed Owen APR 0 S ZOO$
d. Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the SIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and In i ection Sites:
(If multirie_ sites either indicate which sites the information applies to. cop), and paste a new section into the
document for each site. or attach additional pages for each site)
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
H. NEW AND MAJOR MODIFICATIONAPPLICATIONS fLhis section not needed for renewals or minor
modificatiom, skip to next secti'onj
Description Of Waste{Sl And Facilities
1, Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: dyson staff report.doc

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
D Yes D No D NI A. If no, please explain·: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D NIA. Iino, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D N/ A. If no, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D N/A. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D NI A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D NIA If yes, attach list of sites
with restrictions (Certification B?)
IIL RENEW AL AND MODIFICATION APPLICATIONS (use previous section for new or maior modification
systems)
Description Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate #: __
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. Ifno, please explain: __
FORM: dyson staff report.doc 2
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new develop1,11ent, etc.)? If yes, please explain: __
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. If no, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map showing confli9t areas or attach any new maps you have received from the applicant to be incorporated
into the pe~it: __
10. Is the description of the facilities, type and/or volume ofwaste(s) as written in the existing permit correct? D
Yes or D No. If no, please explain: ____ _
11. Were monitoring wells properly constructed and located? D Yes or D No D N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
D No D N/A. Please summarize any findings resulting from this review: __ _
13. Check all that apply: D No compliance issues; □· Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ____ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
D No D Not Determined D N/A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? D
Yes or D No D N/A. If yes, please explain: _. __
FORM: dyson staff report.doc 3
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description OfWell(S) And Facilities-New, Renewal, And Modification
1. Type of injection system:
[gl Heating/cooling water return flow (SA 7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (SL/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? [gl Yes D No
3. Are there any potential pollution sources that may affect injection? [gl Yes D No
What is/are the pollution source(s)? wood pile. What is the distance of the in jection well(s) from the poll ution
source(s)? 30 ft.
4. What is the minimum distance of proposed injection wells from the property boundary? +40 ft.
5. Quality of drainage at site: [gl Good D Adequate D Poor
6. Flooding potential of site: [gl Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency ofmonitor~ng, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [gl Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
In jection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes D No. If yes . explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes, explain:
3. For renewal or modification of groundwater remediation permits (of any typ e), will
continued/additional/modified in jections have an adverse impact on mi gration of the plume or management of
the contamination incident? D Yes D No. If yes, explain: NI A
4. Drilling contractor: Name:
FORM: dyson staff report.doc 4
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address:
Certification number:
5. Complete and attach Well Construction Data Sheet.
FORM: dyson staff report.doc 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
Z. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit`? ❑ Yes U No. If yes, please explain
briefly.
4, List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
S. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
G. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7 Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold.
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
S, Signature of report preparer(s):
Signature of APS egional supervisor:
Rate; �, +
C
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
3-0j
The geothermal system has not been constricted yet. The water supply well was installed by
FORM: dyson staff report -doe 6

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Hudson Well Company, Inc. Te rry Herbin Cert.# 2072 on 9-8-2006
FORM: dyson staff report.doc 7
Permit: WI0500181
SOC:
County: Orange
Region: Raleigh
Effective:
Effective:
Contact Person: William Dyson
Directions to Facility:
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: William Dyson
Facility: William and Persis Dyson
1022 Jefferson Rd
Hillsborough NC 27278
Phone:
Hwy 40 to Old NC 86 South, turn right on Davis Rd., turn right on Orange Grove Rd., turn left on Dimmocks Mill Rd., about .5 miles on
the right.
System Classifications:
Primary ORC:
Secondary ORC(s):
.On-Site Representative(s):
Related Permits:
Inspection Date: 04/03/2008
Primary Inspector: Ed Owen
Secondary lnspector(s):
Michael Rogers
Certification: Phone:
Entry Time: 11 :30 AM Exit Time: 12:30 AM
Phone:
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500181
Inspection Date: 04/03/2008
Inspection Summary:
Owner -Facility: William Dyson
Inspection Type: Compliance Evaluation Reason for Visit: Routine
The geothermal system has not been constructed yet. The water supply well was installed by Hudson Well Company,
Inc. Terry Herbin Cert.# 2072 on 9-8-2006
Page: 2
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: Marcia 18.2008
To: ❑ Landon Davidson, ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt, FRO -APB ❑ Charlie Stehman, WiRO-APS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight, W-SRO-APS
® Jay Zimmerman, RRO-APS
From. Michael Rogers Groundwater Protection Unit
Telephone. [phone] Fax: 9[ 19) 715-0588
E-Maid: Michael.Rogersiancmailmet
A. Permit Number: WI 0500181
B. Owner: William and Persis D►,son
C. Facility/Operation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation[] Reuse ❑ 14-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
® UIC - (5A7) open loop geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Frojecl Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTE:_ I would like to P-o on -site when vou insnect and take some
pictures.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
® Return a Completed APSARR Form.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ issue an Attachment B Certification from the RO.*
* Remember that you wi11 be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
R.O-APS Reviewer:
Date:
FORM; APSARR 07/06 Page ] of t

Michael F. Easley, Governor
William G. Ross Jr- Secretary
North Carolina Department of Environment and Naturai Resources
March 11, 2008
WILLIAM DYSON
1022 JEFFERSON ROAD
HILLSBOROUGH, NC 27278
Subject: Acknowledgement of Application No. W10500181
William and Persis Dyson
Injection Heating/Cooling Water Return Well (5A7)
Orange County
Dear MR DYSON:
Coleen H, Sullins Director
Division of Water Quality
The Aquifer Protection Section of the Division of Water Quality (the Division) acknowledges receipt of
your permit application and supporting materials on February 26, 2008. This application package has
been assigned the number listed above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if
necessary. To ensure the maximum efficiency in processing permit applications, the Division requests
your assistance in providing a timely and complete response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior
to final action by the Division. Please also note at this time, processing permit applications can take as
long as 60 - 90 days after receipt of a complete application.
If you have any questions, please contact Michael Rogers by phone at [phone] or by email at
Michael.Rogers@a ncmail.net. If the reviewer is unavailable, you may leave a message, and they will
respond promptly. Also note that the Division has reorganized. To review our new organizational chart,
go to http:llh2o.ernr.state.ne.us/dciewnenWdwq orgchart.2df.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES
ON THIS PROJECT.
Sincerely, r�
For Debra J. Watts
Supervisor
cc: Raleigh Regional Off ce, Aquifer Protection Section
Permit Application File W10500181
Aquifcr Protection Section 1636 Mai: Service Center
Internet: www.newaterqual ty.org Location, 2728 Capital Boulevard
An Equal 4pportunitylAffirmaWs Action Employer- 50% Reeycledll4°,6 Past Consumer Paper
I` Carolina
aiura!!�
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax I ; [phone]
Fax 2: [phone]
Customer Service; (977) 62M749

01/24/2008 12:30 FAX
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NA TIJRAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR;
TYPE 5-A 7 WELL(S)
__ X~_New Permit Application OR ____ Renewal (check one)
DATE: ..Jeth z5
PERMIT NO, ________ (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/ APP.LICANT(S)
lt]002
RECflVt-8 / DE R /OWQ
UI c --r.TI( ,. :.;rcTIOH
FEB 2 6 2~~1
List~ Property Owner lir.led on property deed (if owned by~ business or government agency, state name of
entity and R representative w/authority for signature): c..t..J 1 1/r~ ~ ' a.,,._._-( /"'::J.e,/-.:s /J
/l/f. _1)\ c>-'/J
(I) MailingAddress: /cJ22 ,.Je//:e,,l';S<r'<A /261 ~4
City: G r-ee.t.A.;;,-6,r"Y'd S1:1:t11::A./LZipCode: Z 7.:-/./~ County: 0u1/ker
Home/Office Tele No.: 3_3;;,(, -2 J 1 -/ b fL Coll No.:
EMAIL~:ts: CL/FV1cfy S.,-vl @ be//.sC1vM, #Jc_/-. ;
(2) Physical Address of Site (if different than above): 2 /c-tJ LJ/,M,(Rl--<o'c4.:!-/W,,I/ ~Cb:4
City; l t(l/.sV&/d i'J ~ StatefvC Zip Code: Z72]cf' County: Ll~'-7 e'.
Home/Office Tele No.: ----------~C~e=ll~N~.: _________ _
EMAIL Address: ______________ _
B. AUTIIORIZED AGENT OF OWNER, lF ANY (if the Per1nit Applicant does not own t11e subject property,
attach a letter from the property owner authorizing Agent to inst.all and operate UlC well)
Company Name: ___________________________ _
Contact Per.ion.,_: _____________ E=M=A,..,JL"-'-'A""'dd..,,re=s=s,.._: _________ _
Address: ______________________________ _
City: ________ Srate: __ ZipCode: ______ County: _______ _
Office Tele No.: Coll No.:
Website Address of Company, if any: _____________ _
GP\J/1 JIC SA 7 w~u Permit l\ppliclllion (Rovis0d 9/2007)
01/24/2008 12:30 FAX
lih 003
C. WELL DRILLER INFORMATION
Company Name: 1g,�k6 a>1 tje f/
Well Drilling Contractor's Name: 7epf-V
NC Contractor Certification No.:
Contact Person;����� �� rf�``s EMAIL Address
Address: /2, O
City: f_1rea4?eev! CO,�_ A /r- Zip Coale: Z7.i 72 County:
r
Office Tejo NoCell Noe7 --Zo " 5 - 94 I ]' . ¢�'z
�_O. Y` f J
D. HEAT PUW CONTRACTOR INIFORMATSON (if different than driller)
Company Name:,9eAvs c t= C6. — _ --
ContactAerson- Cuii+ofLo-t►sr EMAILAddress:
Address: 00 ! 7 51rCy X me hp --
City: � x Zip Cade: 'i�7 � County: CH*T44I+e
Office Tajo No.: Iii-3b=- 71610 Cell No.. °rl$- Z1Sti 7ytIt
E. STATUS OF APPLICANT
Private: X Federal: Commercial:
State: Municipal: _ Native American Lands:
V. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
o ke Parmn&use
G. WELL USE Will the injection wall(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES X— NO
(2) Personal consumption? YES r NO
H. WELL CONSTRUCTION DATA (Skiv to SeStlon I il tkb im ill PeLMft
PROPOSED Well(s) to be constructed far use as an injection well. Provide the data in (1)
through (7) below as PROPOSED construction specifications. Submit Form GW-1 after
consiracrion.
EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through
(7) below to the best of your. knowledge. Attach a copy of Form GW-I (Well Constriction
Record) if aveil ble. ,f
(1) Date to be constructed: `� 7 '� Number of borings: 1
Approximate depth of each boring (riot): .J 6 5
(2) Well casing. Is the well(s) closed? (check either (a.) YES 2L (b.) NO below)
(a) YES X If yes, then provide the casing information below.
Typo: Galvanized otearl -X Black stool Plastic Qtlxer (specify)
Casing thickness, diameter (inches): ,IaS depth: from ....Q to 104 ft. (reference to land surface)
Casing extends above lrraund inches crd-�,Vc c'mU ced�l,-
GPUNIC 5A7 Wcll Permit Application (Revised *2007) ��' Pagc 2

01/24/2008 12:30 FAX ~004
I..
(3)
(4)
(S)
(6)
(b) NO
Grout (rnaterj11l surrounding well casing and/or piping):
(a) Grout type: Cernent__K_ Bentonile Other (specify) ______ _
(b) Grouted surface and grout depth (rafuranco to tand surfaco):
___ Around closed-loop piping; from ___ to __ (feet) .
.. , X __ ,. Around well ca!ling; &om---,-~ to ___ (feet).
Well(s) Screen Information Iii),,,
Depth of Screen: From ____ to ___ feet below land surface yf}A-J Q '
N.C. State Regulations (Title ISA NCAC 2C .0200) require the Pennittee to make provisions for '1 /}_ ,,,~
monitoring wellhead water quality and processes. A raucet on both Influent (groundwater entering heat ~,r --
pump) end Effluent (water being inject back into the well) lines is required. Will ther~ be a aucet on: ,, fl O .
(a). Influent line? Ye!I __ No _____ , (b) .filt1.llml lino'? Yos __ No __ ~ 6 r"-
Source Well Construction Information (if the water source well is a different well than rhe injection well)
Attach a copy of Form OW-l (Well Cons1ruc1ion Record). If Form GW-1 is not available, provide the
followin~ data.:
Groundwater Source. From what depth, fonnation, and type of rock/sediment units will the groundwater
be withdrawn? (e.g. granite, limestone, sand, etc.)
Oepth: _______ Fonnation: ______ Rock/sediment unit: _______ _
jl'.r· Dysr--.
L/jfV/08
NOTE: THB WELL DRlLLINCi OON1RAC'l'OR CAN SUPPLY THE DATA FOR EITHER EXISTING OR Pk.OPOSBD WELLS ff
THIS INFORMATION IS UNA VAILABUl BY OTI ll!R MEANS.
OPERATJNG DATA
(l) l11jection rate:
(2) Injection Volume:
(3)
(4)
lnjKtion Preasu~:
Injection Temperature:
Avorage (daily) S' gallon$ per minute (gpm).
A-Yerage (dllily) __ g1dlons per di!)' (gpd).
A-Yerage (daily} ... ,.,._ ........ pounde/equare inch (psi}.
Average (January) ... ~ ..... ,,, ______ ° F, Average (July) , ___ ° F.
J. INJECTION-RELATED EQUil"MENT
Attach a diagram showing the engineering layout or proposed modification ot' lhe injection equipment and exterior
piping/tubing l'ISsociated with the injection operation. The manufacturer's brochure may provide supplementary
informa1ion.
K.. LOCATION OF WELL(S)
Attach two copies of maps showing the following informaiion:
(I) lnclude a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sourc~s
of groundwater contamination and the orientation of and distancell between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields locued within 1000 feet ofche
geothermal heat pump well system. Label nil features clearly and include a north arrow,
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
OJ'U/UIC jA7 Well Pc11Tiit Applic11tion (Ri:visi:d 9/2007) Page 3
01J2V2008 12:30 PAX 0 005
L. CERTIFICATION
Note: Thin Permlt Application must be signed by tach person appearing on the
recorded legal property deed
"I hcr6y certify, under penalty of law, that 1 have personally examined and am familiar with the information
submitted in this document and all attachmpris theroto and that, heeed Can my inquiry of those individuals
immediately respunsible for obtaining said information, l believe that the information k true, accurate and complete.
l am awatc that tltcrc are significant penalties, including the possibility of tints and imprixsmmem, for submitting
false information, i agree to construct, operate, maintain, repair, and if applicable. abandon (he injection well and
all related appurtcnanres in accordance with the approved specifications and conditions of the Permit-"
Signature. of Property Ownrr/App I ir.Wnl
-
Print or Type Mill Name
Signuturt: of Property Owner/Applicar'l
PrinI or Type Full Name
Signamm of Auihoriasd Agent, if any
Print or Type gull NRmc
Pietist return two copses of the completed Application package To:
North Carolina DENR-DWQ
Aquifer Protection Section
U1C Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone (919) 71S-6935
GPilftIIC SA7 Welt Permit AppliCal ian (Rev isod 9(2007) Pagc']

* �'I '� .4 • z i t '� N ••lV Y r
Orange County Zoning
Surface Water Identification
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"'l i 36'•�x z,t'. _�Z J_ .,;y �.�"i'"i'.."•i,' - y{.. _.._.1 yam.. -.ye-.-. - _i .b�.l;
_ l _�tl .��iti�'�-_• ';? �y''1 :li I
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Owner Information:
eye - : i', �- - 4 . �� �• - ''�
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f'{2003
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TWNSP, TM_, H~K_, LOT_ ---
ORANGE COUNTY
WELL REPORT AND LOG
OWNER NAME: Jl~n ~ ii ~~rn L. ,PHONE: @L 1) I, t/1-0?.Jt,
ADDRESS: ,oa d ~-r-r~cm ~~~ Get:.e/2!J b617J A(c ;:J ?-</J(J
REQUESTEENAME: 1),4scro Witl,arn t PHONE: _____ _
LOCATION: -:J)·r.aroao.d.s g ,· LI 73d •
PER1v.ITT REFERENCE NUMBER: W O [p -00 0 8:J
DRILLING CONTRACTOR: H:wd.soo Wei I
CER~D DRILLER ON SITE:_....,., e.-...r ..... c-y,..._ ..... ·l-\er-'=_p"-"'Uj::L.·.___ _______ _
N.C. REGISTRATION NUMBER: cQO'J ol. PHONE: >.../fJIJ-{300 [
TYPE OF WELL: RESIDENTIAL ✓ OTHER (SPECIFY) __ -----=-------
DATE STARTED:" °!-7-0(p DATECOMPLETED: C,-$--6 l,
IS nns WELL A REPLACEMENT WELL? __ _..:._ __________ _
DISTANCE OF WELL FROM: ---r·
NEAREST w ASTEWATER DISPOSAL SYSTEM: 'DD +:
NEAREST BUILDING FOUNDATION: ' 5C'> t:
NEAREST PROPERTY LINE: 40 +
OTHER POTENTIAL SOURCES OF CONTAMINATION: __
SPECIFY: ---------------
TOTAL DEPTH: 5(e 5
CASING DEPTH: l b 5
TOTAL FLO\V (GPM): 3_
STATIC WATER LEVEL: -'3.=-;S=-----
WATER ZONES:
__ l_GPMAT l l D FT.
°2 GPMAT 53$ FT.
__ GPMAT __ FT.
LINER DEPTII: _______ PACKER BRAND: ______ _
SCREEN INSTALLED? __ ·SCREENINTERVAL: ___ SLITSIZE: __
TYPE AND BRAND OF DRIVE SHOE USED: St AB -::C.Bokl
TYPE AND LENGTH OF TEST FOR WELL YIELD: ----------TYPE AND AMOUNT OF CHLORINE USED: ------------
C01\1MENTS --------------------
I CERTIFY THAT ALL THE ABOVE INFORMATION IS ACCURATE AND TRUE:
CERTIFIED DRILLER \_ 1R.Jl/Vj ~
DATE: q., f-0~
Orange County Health Department
Environmental Health. Division
P,O. Box 8181, 306-C Revere Road
a''
Hiusborough, NC 27278
�' rK•`•,
Phone [phone] Fax [phone]
www.co.orange.nc.us
Pin: 9853965123
Application Date: 03/24/2006
WELL COMPLETION REPORT
TNML: 3.51.3A
Permit number: W06-00082
APPLICANT: DYSON WILLLAM L OWNER: DYSON WILLIAM L
ADDRESS: 1022 JEFFERSON RD ADDRESS: 1022 jEFFERSON R-D
GREENSBORO NC GREENSBORO NC
27410 27410
PHONE: [phone] PHONE: J
Property Dese: EJS SR 1134 P141148 CKS TP Lot Size: 15.773
Property Address: Dimm mks Mill Rd Facility Type: NEW WELL
Permit Type: PRIVATE WELL WW System:
'Permit Issued :0412612006 I N_VIRO MEN-'ALHEAt,TH SPECIaUST _ ,FRS
* REFER TO THE ORANGE COUNTY ENVIRONMENTAL HEALTH FILES FOR OTHER INFORMATION CONCERNING THE
WELL OR SEPTIC SYSTEM.
* NEW OR REPAIRED WELLS MUST BE. PROPERLY CHLORINATED UPON COMPLETION OF THE PLUMBING SYSTEM.
Any Future repairs made to the well must be in accordance with:
Orange County Groundwater Protection Rules as adopted by the Orange County Board of Health.
NC Well Construction Standards, as applicable and
Orange County Environmental Health Division Policies
*AFTER THE INSTALLATION L5 COMPLETE, SOME SETTLING OF THE GROUT MATERIAL AROUND THE CASING MAY TAKE
PLACE. IF IT HAS SETTLED SUBSTANTIALLY, PLEASE CALL THE WELL CONTRACTOR TO CORRECT, OTHERWISE A
SHALLOW VOID (< 2 FEET) CAN BE FILLED WITH CEMENT WHEN A SLAB IS POURED-
* Comments:
WELL CONSTRUCTION INSPECTION
TOTAL DEPTH:
565
CASING DEPTH:
IOS
YIELD& grn, C&
WATER ZONE DEPTH feet
1 ,
110
STATIC WATER LEVEL:
35
2,
535
GROUT TYPE:
Sand Mix
U ,
0
GPS #:
0 ,
0
LINED DEPTH.
0
WELL CONTRACTOR: HCIDSON WELL CO. —�
APPROVED :0911112006 lr
ENVIRONMEi TAT HEALTH SP CLALIST
rl.
F_H WP 413 0/0 2 Pick up MailFile
Reviewed

You Count In Orange County
Page I of 1
ti
Orange County N.G. 91S Ma
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ED
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his map contains parcels prepared for the inventory of real property within orange County, and Is compiled from recorded deeds. plats, and
Cher pub4ic records and data. Users of this map are hereby notifled that the aforementioned public primary information sources should be
con sulted for verification of the information contained on this map. The county and its mapping companies assume no legal responsibility for the
information contained on this map.
This Page Printed Friday, November 4, 2005 9:22 am
Parcels Current Thru 10/31/2005. Owner Information Current Thru 10/19/2005
Parcel Identification Number: 9853965123
r Summary r Building F Land F Documents F Prior Owners F Addresses
Create -Print Data.Page- :
http:llgis.co,or nge.nc.uslservleticom.esri.esrimap.Esrimap?ServiceName=YouCountGIS&ClientVersion 11./412005

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SURVEY OVERLAP NOTE:
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_ (OVERLAP AREA - 5.053 ACRES)
1501.53'� N 85°05'S � P/O LOT 24
~� 3
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}� APPROXIMATE LOCATION OF P/0 LOT 24
fl TOWNSHIP LINE SCALER FROM
TAX MAP 'n r
PLAT BOOK 13-25 REFERENCES DEED BOOK 118-393 1/2 TWIN OAK 6�
AS IT'S TIRE SOURCE. D.B. 118-393 1/2 DOES NOT APPEAR WILUAM P 4'
TO COVER THE AREA WfiHIN THE OVERLAP. D.B. I �
P.B. 13-25 APPEARS NOT TO INCLUDE LOT 24 IN TTS CERTIFICATION.
P-B. 13-25
NOTE:
ENTIRE LOT LIES WrrHIN THE UPPER ENO RNER WATERSHED

YY
or

QF uvH r��
Michael F. Easley. GDvernor
1 1.
�,; William G. Ross 3r„ 5ecretary
jy north Camlina Department ofEnvirorunentand Natural Resources
Coleen H. Sullins, Direztor
Division of Water Quaiity
ltl�• _ , 'IHiX
William and Persis Dyson
1022 Jefferson Road
Greensboro, NC 27410
Re: Laboratory Analytical Results
Permit No. W10500181
Issued to William and Persis Dyson
Dear Mr. and Mrs. Dyson;
Please find attached the laboratory analytical results of the water samples collected from your
UIC well on June 12, 2008. The samples collected had exceedances in the maximum
contamination level (MCL) for the following parameters: total coliform, total dissolved solids,
and sulfate. Due to the elevated coliform, it is required that you chlorinate your well. If you
plan to use the water from the well for drinking purposes, it is recommended that you use a water
filtration system,
If you have any questions regarding your permit or the Underground Injection Control (UIC)
Program please call Mr. Qu Qi at [phone] or me at [phone].
Best Regards,
Michael Rogers
Environmental Specialist
GPU — UIC Control Program
cc: Jay Zimmerman — Raleigh Regional Office
Central Office File — WI0500181
Orange County Health Department
Attachment(s)
pp IbCamlina
,Vaturally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: [phone]
lntcmet; lttm:Jlwww nG�v iterguullt�.nrg 2728 Capital Boulevard Raleigh, SIC 27604 Fax 1; [phone]
Fax 2: [phone]
An Equal apportunitylAinative Action Employes— 5G% Recycle V0% Post Consumer Raper Customer Service: [phone]

NC DEPARTMENT OF ENV & NATURAL RESOURCES
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
1636 MAIL SERVICE CENTER
RALEIGH NC 27699-1636
RE:t;EIVED I DENR 'l ~WQ
AQUIFf:RPROTFr.TION SECTION
AU6 ;01 ·2Q
016H2'3507019
--~vrcE REQUESTED $00.34~ ..
07/25/2008
us Pos-rAGE
~t:T'U~N "'tO j~~r,@jlt 1 ~O~Q o.e 0'7/$t;J/Q8
DYSON
2100 OIMMOCKS MZ~L RC
HIL.L.SBOROUGH NC 272'78--7'894
RETURN TO SENOER
I, 1l1 II, 11!1ll1 I 1,1, 'I, I 1111,ll1ll1111ll11l 111!1111l,I I 1111l1l
Michael F. Easley, Gnvcrnor
William G. Ross Jr., Secretary
Nor[h Carolina Department of Environment and Natural Resources
Coleen H. SuIlins. Director
Division of Water Quality
William and Persis Dyson
1022 Jefferson Road
Greensboro, NC 27410
Re: Laboratory Analytical Results
Permit No. WI0500181
Issued to William and Persis Dyson
Dear Mr. and Mrs. Dyson:
Please fn.d attached the laboratory analytical results of the water samples collected from your
UIC well on June 12, 2008. The samples collected had exceedances in the maximum
contamination level (MCL) for the following parameters: total coliform, total dissolved solids,
and sulfate. Due to the elevated coliform, it is required that you chlorinate your well. If you
plan to use the water from the well for drinking purposes, it is recommended that you use a water
filtration system.
If you have any questions regarding your permit or the Underground Injection Control {UIC}
Program please call Mr. Qu Qi at [phone] or me at [phone].
Best Regards,
f
Michael Rogers
Environmental Specialist
GPU — UIC Control Program
cc: Jay Zimmerman -- Raleigh Regional Office
Central Office File — W10500181
Oran ge County Health Department
Attachment(s)
NorthCarolins
Alatuivlly
Aquifer Protection Section I636 Mai! Service Center Raleigh, NC 2 7699 -163 6 Telephone: [phone]
Internet: I1tm:IIA'WW.nC�L'a[erOn3l3R'.OTF� 2728 Capital Boulevard Raleigh, NC 27604 Fax is [phone]
Fax 2; [phone]
An Equal apportunitylAffirmative Action Employer— 5 G% Recycled 110% Post Consumer Paper Customer sevice: [phone]

LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: WI 0500181
PERMITTEE: William Dyson
SAMPLE COLLECTED DATE: June 12, 2008
Coliform, total Coliform, fecal pH
1 CFU/100ml 1 CFU/100ml units
MCL=1 MCL=1 MC L = 6.5-8.5
Influent 1 7 7.66
Effluent 1 5 7.35
NO2· + NO3-as N Phosphorus Nitrate
mg/L mg/L mg/L
MCL= 10 MCL=nss MCL= 10
Influent <.02 <.02 <.02
Effluent <.02 <.02 <.02
Calcium, Ca Cadmium.Cd Chromium, Cr
mg/L ua/L ua/L
MCL= nss MCL = 1.75 MCL=50
Influent 180 <1 <10
Effluent 180 <1 <10
Manganese, Mn Sodium, Na Nickel, Ni
µg/L mg/L µg/L
MCL= 50 MCL= nss MCL = 100
Influent 34 38 17
Effluent 34 38 14
MCL = Maximum Contamination Level per NCAC 2L .0200 (GA Standards)
nss = no state standard
na = not analyzed
Total Dissolved Solids
mg/L
MCL=500
700
697
Nitrite
mg/L
MCL= 1
<.01
<.01
Copper, Cu
ua/L
MCL = 1000
23
21
Lead,Pb
µg/L
MCL = 15
<10
<10
•The laboratory sample matrix interfered with the ability to to make any accurate determination; Estimated
Chloride, Cl
mg/L
MCL=250
3.1
3.1
Silver, A g
ua/L
MCL= 17.5
na
na
Iron, Fe
ug/L
MCL= 300
55
<50
Selenium, Se
µg/L
MCL= 50
na
na
Flouride
mg/L
MCL=2
0.8
0.8
Aluminum, Al
uQ/L
MCL=nss
<50
<50
Mercury, Hg
µg/L
MC L = 1.05
na
na
Zi nc, Zn
µg/L
MCL =1050
1000
860
Sulfate Ammonia, NH3 TKN
mg/L mg/L mi:i/L
MCL=250 MCL= nss MCL= nss
380 <.02 <.2
420 <.02 <.2
Arsenic,As Barium, Ba
uq/L µg/L
MCL=50 MCL=2000
na n/a
na n/a
Potassium, K MaQnesium, Mg
m!:!/L mg/L
MCL=nss MCL=nss
na 3.6
na 3.5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 04/02/2008
To: A q uifer Protection Section Central Office
Central Office Reviewer: Michael Ro gers
Regional Login No: 05
L GENERALINFORMATION .
County: Oran ge
Permittee: William and Persis D yson
Project Name: UIC-(5A7) O pen Loop
Application No.: WI0500181
1. This application is (check all that apply): 181 New D Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals D Attachment B included O 503 regulated D 503 exempt
D Distribution of Residuals D Surface Disposal
D Closed-loop Groundwater Remediation 181 Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? 181 Yes or D No.
a. Date of site visit: 04/02/2008
b. Person contacted and contact information: William D yson, Phone# [phone]
c. Site visit conducted by: Ed Owen
d. Inspection Report Attached: 181 Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
c.....
C r
00
I".,)
c:::)
c:::)
00
181 Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions: __
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For Disposal and Injection Sites:
~~
C: C')
W' !!! .... < -om ao s-oO ~m Oz ::, ::u en_
~o g-~
=> 0
(If multi ple sites either indicate which sites the information applies to , copy and paste a new section into the
document for each site , or attach additional pa ges for each site)
a. Location(s): __
b. Driving Directions: __
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
H. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section )
Description Of Waste (S) And Facilities
1. Please attach completed rating sheet. Facility Classification: __
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: dyson staff report.doc
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
D Yes D No D N/ A. If no, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D N/A. Ifno, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D N/A. lfno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D N/A. If no, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D N/A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
IIL RENEWAL AND MODIFICATION APPUCATIONS (use previous section for new or maior modification
systems)
Description OfWaste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate #: __
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. If no, please explain: __
FORM: dyson staff report.doc 2
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit ( drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: __
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. If no, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? 0 Yes or D No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? 0 Yes D No O N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or O No. If yes, please attach a
map showing confli~t areas or attach any new maps you have received from the applicant to be incorporated
into the permit: __
10. Is the description of the facilities, type and/or volume ofwaste(s) as written in the existing permit correct? D
Yes or D No. If no, please explain: ____ _
11. Were monitoring wells properly constructed and located? D Yes or D No D NIA. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
D No D N/ A. Please summarize any findings resulting from this review: __ _
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; 0 Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ____ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
D No D Not Determined D N/A .. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? D
Yes or O No D N/ A. If yes, please explain: __
FORM: dyson staff report.doc 3
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation eflluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description OfWell(S) And Facilities-New. Renewal, And Modification
1. Type of injection system:
[8] Heating/cooling water return flow (5A7)
0 Closed-loop heat pump system (5QM/5QW)
0 In situ remediation (51)
0 Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
0 Other (Specify: )
2. Does system use same well for water source and injection? [8J Yes D No
3. Are there any potential pollution sources that may affect injection? IZ! Yes D No
What is/are the pollution source(s)? wood p ile. What is the distance of the in jection well(s) from the pollution
source(s)? 30 ft.
4. What is the minimum distance of proposed injection wells from the property boundary? +40 ft.
5. Quality of drainage at site: IZ! Good D Adequate D Poor
6. Flooding potential of site: IZ! Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency ofmonito~ng, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater mon~toririg program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [8J Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
In jection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes D No. If yes. exp lain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes , explain:
3. For renewal or modification of groundwater remediation permits (o f an y typ e), will
continued/additional/modified in jections have an adverse impact on mi gration of the plume or mana gement of
the contamination incident? D Yes D No. If yes , exp lain: N/ A
4. Drilling contractor: Name:
FORM: dyson staff report.doc 4
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address:
Certification number: __
5 . Complete and attach Well Construction Data Sheet.
FORM: dyson staff report.doc 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Y. EVALUATIONAND RECOMMENDATIONS
1, Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yea, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recom=end to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons;
8. Signature of report preparers):
Signature ofAanal supervisor:
Hate:LL;
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
The geothermal system has not been constructed yet. The water supply well was installed by
FORM: dyson staff report.doc 6

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Hudson Well Company. Inc. Terry Herbin Cert.# 2072 on 9-8-2006
FORM: dyson staff report.doc 7
Permit: WI0500181
SOC:
County: Orange
Region: Raleigh
Effective:
Effective:
Contact Person: . William Dyson
Directions to Facility:
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: William Dyson
Facility: William and Persis Dyson
1022 Jefferson Rd
Hillsborough NC 27278
Phone:
Hwy 40 to Old NC 86 South, turn right on Davis Rd., tum right on Orange Grove Rd ., turn left on Dimmocks Mill Rd ., about .5 miles on
the right. System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
.On-Site Representative(s):
Related Pennlts:
Inspection Date: 04/03/2008
Primary Inspector: Ed Owen
Secondary lnspector(s):
Michael Rogers
Entry Time: 11 :30 AM Exit Time: 12:30 AM
Phone:
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500181
Inspection Date: 04/03/2008
Inspection Summary:
Owner • Faclllty: William Dyson
Inspection Type: Compliance Evaluation Reason for Visit: Routine
The geothermal system has not been constructed yet. The water supply well was installed by Hudson Well Company,
Inc. Terry Herbin Cert.# 2072 on 9-8-2006
Page: 2
i
County:
ORANGE
—
River Basin
Report To
RROAP
Collector.
J GPEEf
Region?
RRO
Sample Matrix.
GROUNDWATER
Loc. Type.
WATER SUPPLY
Emergency YeslNo
Sample ID.
PO Number #
Date Received.
Time Received-
Labworks LoginlD
Date Reported -
Report Generated-
COC Yes/No N tl ` i`� 4:Lu1U r`: VisitlD
Loc. Descr.: 131LL []Y8�[ N
Location ID RROAPNLC Collect Date- 06112J2006 Collect rme10.00 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dw91ab.org under Staff Access
A Value reported is the average of two or mare determinations
81-Countable membranes with <20 colonies; Estimated
82• Counis from all 6liars were zero-
0 3- Countable membranes with mare than 60 or a colonies: Estimated
84-1711ters have counts of both >60 or 80 and s 20: Estimated
B5-Toe many colonies were present, too numerous to count (TNTC)
J2- Reported value failed to meet QC criteria far either precision or accuracy: Estimated
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis was from an unpreserved or improperly chemically preserver) sample; Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
ABMIS
acasse
0611212008
12:50
MMATHIS
8WX13
06/27/2008
tIsz)�cg
N3-Estimated concentration is c PQL and >MDL
NE-Noestabfished PQL
P-Elevated PQL due to matrix interference andfor sample dilution
R1-Hold ing time exceeded prior to receipt at lab•
02- Holding time exceeded following receipt by lab
PQL- Practical 0uantxation Limit-sukt(ect to change due to instrument sensitivity
U- Samples analyzed for this cam powid but not detected
X1. Sample not analyzed for this compound
Laboratory Section» 1623 Ma11 Service Center, Raleigh, NC 27699-1623 (9191 733.3908 Page 1 of 3

WC ©WQ. La6oratory Section 1?.§su{ts Sample ID AB31275
Locaqon ID: RROAPNLC Collect Date: 06/12/2008
Lee. Descr.: BILL DYSON Collect Time:: 10:00
Visit ID
CAS# Analyte Name PQL Result Qualifier Units AnalysVDate Approved By /Date
Sample t.emperature at receipt by lab 2.1 ·c DSAUNDERS MMATHIS
Method Reference 6/12/08 6/12/08·
MIC
Coliform, MF Fecat In llquld B2 CFUNOOml PCOTTEN MOVERMAN
Method Reference APHA9222D-20th 6/12/08 6/17/08
Collfonn, MF Total In Hquld 7 ;.1 ... .21 CFUl100ml PCOTTEN MOVERMAN
Method Reference APHA9222B-20th ~.() ... '> 6/12/08 6/17/08
Alkallnlty to pH 4.5 of liquid _TITLE_ mgtLascaco3 NDEO MOVERMAN
Method Reference APHA2320B-20th 6/16108 6120/08
Alkallnlty4.5 72 mgfL as CaC03 NOEO MOVERMAN
Method Reference APHA2320B-20th 6/16/08 6/20/08
Alkallnlty8.3 u mgfL as CaC03 NOEO MOVERMAN
Method Reference APHA2320B -20th 6/16/08 6120/08
Bicarbonate 72 mgfl as CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 6116/08 6/20/08
Carbonate u mgfl as CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 6/16/08 6/20/08
pH_Alkallnlty 7.66 mglasCaC03 NDEO MOVERMAN
Method Reference APHA23208-20th 6/16/08 6/20/08
WET
Ion Chromatography _TITLE_ mgfl MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 6119/08 6127/08
Total Dlssotved Solids In llquld 12 700 mgfl AWILLIAMS MOVERMAN
Method Reference APHA2540C-18TH 6/18/08 6/23/08
Ollorlde 1.0 3.1 mgfl M1BRAH 1M1 MOVERMAN
Method Reference EPA300.0 6/19/08 6/27/08
Fluoride 0.4 0.8 mgfl M1BRAHIM1 MOVERMAN
Method Reference EPA300.0 6/19/08 6127/08
Sulfate 2.0 380 mgfl MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 6119108 6127/08
NUT
NH3 es N In Uquld 0.02 0.02 u mgflesN MOVERMAN CGREEN
Method Reference Lac10-107-06-1-J 6113/08 6/17/08
Total Kjeldahl N es N In llquld 0.2 0.20 u mgflasN GBELK MOVERMAN
Method Reference Lachat107-06-2-H 6119/08 6120/08
NO2+NO3 as N In llquld 0.02 0.02 u mgflasN MOVERMAN CGREEN
Method Reference Lac10-107-04-1-c 6/13108 6/17/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 3
NC CDWQ, La6oratory Section <.R§sults Sample ID AB31275
Location ID: RROAPNLC Collect Date: 06/12/2008
' Loe. Descr.: BILL DYSON Collect Time:: 10:00 ..
Visit ID
CAS# Analyte Name PQL Result Quallfler Units Analyst/Date Approved By /Date
Phosphorus_total as P In liquid 0 .02 0.02 u m asP MAJAYI MOVERMAN
Method Reference Lac10-115-01-1EF 6/16/08 6/19/08
Nitrate as N In liquid 0 .02 0.02 u mg/LasN MOVERMAN MOVERMAN
Method Reference Lachat107.IJ4-1-e 6/18/08 6/18/08
Nitrite as N In liquid 0 .01 0.01 u mgllasN MOVERMAN MOVERMAN
Method Reference Lachat107-04-1-e 6/12/08 6/18/08
MET
7429-90-5 AlbylCP 50 50 u ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.7 6/17108 6/23/08
7440-70-2 CsbylCP 0 .10 180 mg/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7440-43-9 CdbylCPMS 1.0 1.0 u uglL SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7440-47-3 CrbylCPMS 10 10 u ug/L SGOSS ESTAFFORD
Method Reference EPA200.8 6117/08 6/23/08
7440-50-8 CubylCPMS 2.0 23 ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7440-48-4 FebylCP 50 55 ug/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6123/08
7439-95-4 MgbylCP 0 .10 3.6 mglL DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7439-96-5 MnbylCP 10 34 ug/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7440-23-4 NabylCP 0.10 38 mg/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7440-02-0 NlbylCPMS 10 17 ug/L SGOSS ESTAFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7439-92-1 PbbylCPMS 10 10 u uglL SGOSS ESTAFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7440-66-6 ZnbylCPMS 10 1000 uglL SGOSS EST AFFORD
Method Reference EPA200.8 6117108 6/23108
Laboratory Section» 1623 Mall Service Center, Raleigh, NC ·27699-1623 [phone] Page 3 of 3
North Carolina
GROUNDWATER FIELDILAB FORM Department of Environment and Natural Resources
flWISION OF WATER QUALITY - GROUNDWATER SECTION
County
Quad No
Lat.
Long
No.
SAMPLE TYPE
CiViater
❑ Soil
❑ Other
Report To. ARO, FAO, MRO RO, aRO, WiRO, JI ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: B s, Courier and Dei,.Other-
Colieo#or s • �� Purpose:
(} date � z. / ;9 9' Time -.,Z 0 47 Baseline,
0
Lab Number
Date Received - Tirrte _1250
ReC'd by:__q_ From: Bus, Courier, an Del.,
Other:
Data Entry By:_
Date Reported:
Ck:
Coffoanc%LUSST, Pesticide Study, Federal Tru -, Other: I_ !_C _ Y v
FIE N Owner .4 C�fI
pH4W , Spec. Cond.94 at 25o C Location or site L/ I
Temp.ie _IR .t_ oC Odor , df+l _ Description of sampling point
Appearance Sampling Method S6tylple Interval
Field Analysis By: ^ _ �i Remarks _ t— e� f / Ez
LABORAIQBY
BOD 310 m fl iss, vlids 0300 m I A = Silver 466M u A Or anochlorine Pesticides
COD High 340 mg/l
Flouride 961 m
-Al- Aluminum 46557 u n
Organophosphorus Pesticides
COD Law 335 m
t
As - Arsenic 48561 u
Nitro en Pesticides
-Coliform: MF Fecal 31616 1100m1
Hardness non -cart got
Ba - Barium 46658 u n
Acid Herbicides
�—
Conform: MF Total 31504 1100mi
Ca - Calclum 46552 m
PCB,,
TOC 680 MgA
Sucific-Cond.Cd
- Cadmium 46&% MgA
Turbidity 76 NTU
Sulfate 945 will
-Cr - Chromium 46560 uco
Resldue., Suspended 53o mgA
Sulfide 746 m
Cu - Copper 46662 u
i
Fe - Iron 46563 ugA
Semivotatile Organics
OH and Grease m A
H - Mercua 719M UgA
TPH - Diesel Range
unit
K - Potassium 46555 mgA
Alkalinity to pH 4.5 410 nw
-M - Ma nesium 46554 m
Alkalinity to pH 8.3 415 mgR
"Mn - Manganese 48W5 u li
Carbonate 445 mgA
H as N 610
Me - Sodium 46558 m
Volatile Organics (VOA bottle)
Blcarbonate 440 m I
-EqA
L'
TPH - Gasoline Range
Cgarbon dioxide 405 m9A`�
NO + ND as N fi30 MQA
Pb -Lead 46564 u n
TPH . BTEX Gasoline Range
Chloride 940 mgR
P: Total as P 685 m
e - Selenium u A
Chromium: Hex 1032 uqA
Zn - Zinc 46587 Lzrill
Color. True so CU
Cyanide 720 mgli
y
Lab
G4::) -6-
01
_n-cr _'9.
GW-54 REV. I P'
For Dissolved Analysis - submit tiltered`sample and write "DES" In blo,

M
M
LaboratoL l
,section {I esufts
I , County: ORANGE
Sample fQ: A031276
River Basin
Report To RROAP
Collector. 3 GREER
Region: RRo
PO Number#
Cuts Received:
Time Received:
tabworks Loginl0
Sample Matrix: GROUNDWATER �r l �U [7a1e Reported:
tot. Type: WATER 5UPPtY 41� `l 1 [�f►] Report Generated:
Emergency Yes/No
� '-Il+} Vrsitt4
COC Yes1No
Loe_ oeser.: O]LUAYSt�N
Location 10: RROAPNLC Cofleet Date: 06117Jxt]a8 Coiled Time:. 10.30 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier nodes refer to www.dwglab.org under Staff Access
A -Value reported is the average of Iwo or more determinations
Bi-Countable membranes with t20 colonies; Estimated
82- Counts from all Titers were zero.
B3- Countable membranes with more than 60 or 80 colonies; Estimated
Ba Filters have counts of both �-60 or 80 and r 20; Estimated
85-Too many colonies were present; too numerous to count (TNTC)
32- Reported value failed to meet QC criteria for either precision or accuracy; Estimated
S3-The sample matrix interfered with the ability to make any accurate determination; Estimated
.16-The lab analysis was from an unpreserved or Impro party chemically preserved s3mp1w Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
8GO669
061121200E
12:50
MMATHIS
6127108
0612712008
&1ZD/0g
W-Estimated concentration is-r POL and >MDL
NE -No established PQL
P-Oevated PQL due to matrix interference andlor sample dilution
Q1-Holding time exceeded prior to receipt at lab.
02- Holding time exceeded fotlorving receipt by lab
PQL- Practical 0uantitafion Limit -subject t0 change due to instrument sensitMty
U-Samples analyzed for this compound but not detected
XI- Sample not analyzed for this compound
Laboratory Sect3ortaa 16a3 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 1 of 3

j.ocation lC}:
'l.oc. Descr.:
Visit ID
MIC
WET
NUT
RROAPNLC
BILL DYSON
WC <DWQ £a6oratory Section (J?gsu{ts Sample ID
Collect Date:
Collect nme::
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date
Sample temperature at receipt lab
Method Reference
Collfoon, MF Fecal In liquid
Method Reference APHA92220-20th
Collfoon, MF Total In Oquld
Method Reference APHA9222B-20th
AlkaRnlty to pH 4.5 of liquid
Method Reference
Alkallnlty4.5
Method Reference
AlkallnltyS.3
Method Reference
Bicarbonate
Method Reference
Carbonate
Method Reference
pH_Alkallnlty
Method Reference
Ion Chromatography
Method Reference
APHA2320B-20th
APHA2320B-20th
APHA2320B-20th
APHA2320B-20th
APHA2320B-20th
APHA2320B-20th
EPA300.0
Total DISSOived Solids In liquid
Method Reference
Chloride
Method Reference
Fluoride
Method Reference
Sulfate
Method Reference
NH3 as N In Hquld
Method Reference
APHA2540C-18TH
EPA300 .0
EPA300.0
EPA300.0
Lac10-107--06-1.J
Total l(Jeldahl N as N In liquid
Method Reference lacha\107-06-2-H
12
1.0
0.4
2 .0
0 .02
0.2
N02+N03 as N In llquld 0.02
Method Reference Lac10-107-04-1-c
1 82
5 ~-vi? o/ f,{)t-.
_TITlE_
70
u
70
u
7 .35
_TITLE_
897
3.1
0.8
420
0.02 u
0.20 u
0.02 u
Laboratory Section>> 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
CFU/100ml
CFU/100ml
rng/L as CaC03
mgfL as CaC03
mgfL 85 CaC03
mg/Las CaC03
mg/L BS CaCQ3
mg/I.. as CaC03
mg/I..
mg/L
mg/L
mg/L
mg/L
mg/LasN
rrig/1.. as N
mg/LasN
□SAUNDERS
6/12/08
PCOTTEN
6/12/08
PCOTTEN
6/12/08
NDEO
6/16/08
NDEO
6/16/08
NDEO
6/16/08
NDEO
6/16/08
NDEO
6/16/08
NOEO
6/16/08
MIBRAHIM1
6/19/08
AWILLIAMS
6/18/08
MIBRAHIM1
6/19/08
MIBRAHIM1
6/19/08
MIBRAHIM1
6/19/08
MOVERMAN
6/13/08
GBELK
6/19/08
MOVERMAN
6/13/08
Page 2 of 3
AB31276
06/12/2008
10:30
Approved By /Date
MMATHIS
· 6/12/08
MOVERMAN
6/17/08
MOVERMAN
6/17/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6120/08
MOVERMAN
6120/08
MOVERMAN
6/27/08
MOVERMAN
6/23/08
MOVERMAN
6/27/08
MOVERMAN
6/27/08
MOVERMAN
6/27/08
CGREEN
6/17/08
MOVERMAN
6/20/08
CGREEN
6/17/06
9VC DWQ Laboratory Section Resurts Sample ID AB31276
Location'10; RROAPNLC
Collect Date: 06112I2008
Loc, Descr.: BILL DYSON
Collect Time;: 10:30
Visit ID
CAS # Analyte Name PQL Result Qualifier Units Analyst/Uste Approved By [Gate
as P In Hattlp U.U2 UAM U F119" as
Method Reference Lac 10-115.01-1EF 6116M8 all9108
filtrate as N In liquid 0.02 0.02 U nVL as N MOVERMAN MOVERMAN
Method Reference Lachat107-04-1-c 6f13108 6118108
NRr is 8s N In liquid 0.01 0.01 U mg►L as N MOVERMAN MOVERMAN
Method Reference Larhat107.04-1-c 6(12108 8118108
MET
7429-90-5 AI by ICP 50 50 U LVL DSTANLEY ESTAFFORD
Mslhod Reference EPA 200.7 611710E 6123078
7440-70-2 to by ICP 0.10 180 rng/L DSTANLEY ESTAFFORD
Method Reference EPA 200.7 611501 614310E
7440.43-9 Cd by ICPMS 1.0 1.0 U uglL SGOSS ESTAFFORO
Method Reference EPA200.8 611710E w3ms
744"7-3 Cr by ICPMS 10 10 U ugfL SGOSS ESTAFFORD
Method Reference EPA 2CO.8 607108 812310E
7444-50-8
Ca by ICYMS
2.0
21
UgIL
SGOSS
ESTAFFORD
Method Reference
EPA 200.a
611710E
612.3108
7440-48-4
Fe by ICP
59
50 U
u9IL
DSTANLEY
ESTAFFORD
Method Reference
EPA200.7
611610E
623108
7439.95-4
Mg by ICP
0.10
3.6
mglL
DSTANLEY
ESTAFFORD
Method Reference
EPA200.7
611610E
w3108
7439.96-5
Mn by ICP
10
34
UWL
DSTANLEY
ESTAFFORD
Method Reference
EPA 200.7
6,fi6ID8
6043 08
7440-23-4
N8 by lCP
0.10
38
nrglL
MTANLEY
ESTAFFORD
Method Reference
EPA 200.7
6116M
er"O8
7440-02-0
N1 by iCPMS
10
14
ilg(L
SGOSS
ESTAFFORD
Method Reference
EPA200A
6/17M
5123ma
7439-92-1
Pb by ICPM&
10
10 U
ugfL
SGOSS
ESTAFFORD
Method Reference
EPA 200.8
5117108
6R3I)8
7440-66�
Zn by ICPMS
10
860
uglL
SGOSS
ESTAFFORD
Method Reference EPA 200.E 6fl7mli 812810E
Laboratory Section'- 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 3 of 3

GROUNDWATER FIELDILAB FORA
County
Quad No Serial No.
Lat.
Long.
Report To: AAO, FRO, MRO, BD,-1ftRO, WiRO,
MMPLE TYPE
❑wgter
❑ Soil
❑ Other
§MLEPRIORITY
Coutlne
❑ Emergency
111 ❑ Chain of Custody 111
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bu , Coud end Dew_ her
Collectors): 60 Date J 2, P f�: Time
North Carolina
Department of Environment and NatuTal Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
0
Lab Number -OLY ROO-1 _MV/ `21-a
Date Received Time
Re: `d by: ? _ From: Bus, Courier, tan Del.,
Other:
Data Entry By: Ck:
Date Reported:
Purpose:
Baseline, Complaint, Compliance LUST, Pesticide Study, Federal Tr(q Qlarh ) U) c
FlE D ANAL E Owner ! � o"s�
pH400 '2 _. iv Spec. Cond'94 at 25' C Location or site _1
Temp.,fl Z � oC Odor t•ly.J a Description of sampling point a
Appearance cid-A= Sampling Method Sample Interval
Field Analysis By: B R ' , -�- Remarks "�1°''
YSES iwmWrq Go. eir tomR. almj
BOt] 310 m 1
iss. Solid 70300 maA
Ag - Silver 46566 u
Or anochlorine Pesticides
COD High 340 mgli
Flourlde 951 m I
AI - Aluminum 46557 UCAA
Organophosphorus Pesticides
COD Low 335 m
al 990 mo
As - Arsenic 45951 u_qA
Nbogen Pesticides
ollform: MF Fecal 31616 1100ml-Hardiness
fnon-carbi 902 m li
$a - Barium 465M U0
Acid Herbicides
Colflorm: MF Total 31504 1100ml
I
Phenols 32730I
Ca - Calcium 46852 mil
PCB-s
TOC 680 mgA
5opcificCd
- Cadmium 46559 u
Tuibidiiy 78 NTU
ulfate 945 m
Cr - Chromium 46560 u
Residue., Suspended 530 mgli
Suifida 745 m
Cu - Copper 46%2 uQA
Fe - Iron 46563 UgA
Semivolatile Organics
Oil and Greaaa MgA
H - MOMIlry 719M ugh
TPH - Diesel Range
pH 403 un'
K - Potassium 46555 m
Alkalinity to pH 4.6 410 mgli
- Magnesium 46554 m
Alkalinity to pH 8.3 415 mg11
Mn - Manganese 4&%5 v R
Carbonate 445 mgll
J__
NH as N 610 m:Na
- Sodium 46556 MaA
Volatile Organics (VOA bottle)
Bicarbonate 440 m
TPH - Gasoline Range
Carron dioxide 405 m
+ NO w N SW maA
L
Pb - Lead 48564 u
TPH - RTEX Gasoline Range
Chloride 940 mgll
: Total as P 6B5
Se - Selenium uqA
Chromium: Hex ion u I
,
n - Zinc 46587 u 11
Color. True 8o Cu
+-•ifl+�'
Cyanide 720 mgll
Lab Comments: 14'11_-PvrTvl z, .. f1-- err
{I'��:7
a` �� =7
_ r- For Dissolved Analysts - submit filtered sdrriple and write "DIS" in blr

y L1"'I L+YYL.! North Carolina
GROUNDWATER FIELDILAB FORM r� u'f r �roraction Section Department of Environment and Natural Resources
DIVISION OF WATER DUALITY - GROUNDWATER SECTION
County �-� MMPLE TYPE M_PLE RRICRITY
Quad No. Serial No. ��ter ErKoutine
❑ Soil ❑ Emergency
Lat. Long. ❑ Other
Report To: ARO, FRO, MRO,695�WaRO, WiRO, III ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: tau Couri6 Hand 17e ,_ her
`=� _ -- Purpose:
Collector(5): , Date C L'-- 2.e- Time Baseline,
197
Lab Number _R)'/ ::2 I
Date Received f0-ILO Time
Rec'd by: _ From: Sus, Courier,
Other:
Data Entry By: Ck:
Date Reported:
Del.,
Complianc%,' VSa, Pesticide Study, Federal TrpstS e_rr
t-IELIJ ANALYSES Owner 1.) 1 ---) -
pR400 : _ 4 Spec. Cond.y4 —7 5at 251 C Location or site , -S Z1.1 I I
Temp.ta oC Odor A,�Qkj e _ Description of sampling point Lo J
Appearance C1r— . Sampling Method . Sample Interval
'- --, w� t u a. �c.+
Field Analysis By: Remarks _G -- �--��-- _ _
LABORATORY ANALYSES
BOD 310 m r— Criss. Solids 7 300 MW A - Silver 46566 uqA Or anochlorine Pesticides
COD High 240 mgll Flouride 951 m A Al - Aluminum 46557 u A Organophosphorus Pesticides
COD Low 33s m 11
1�_Hardness:
Total goo MW
As - Arsenic 46551 u A
Nitrogen Pesticides
Coliform: MF Fecal 31616 y100ml
t
Hardness fnon-carb 902 m A
Ba - Barium 46558 u A
Acid Herbicides
Coliform: MF Total 31504 /100mil
Phenols 327A
Ca - Calcium 46552 ma/1
PC13's
TOC 680 mgA
&ecificM s
cr
-Cd - Cadmium 46559 u m
Turbidity 76 NTtJ
SuffatB 945 m 11
Cr - Chromium 4656o u Il
Residue., Suspended 530 mgA
Sulfide 745 m
Cu - Copper 46562 u 11
Fe - iron 46563 ugfl
Sermivolatile Organics
oil and Grease rn 11
Hg - Mercury 71900 u I
TPH - Diesel Range
L
pH 403 unit
K - Potassium 46555 m 11
[
Alkalinity to pH 4.5 410 mgR
-1A _ Ma nesium 46554 m yl
t�
-Alkalinity to pH 8.3 415 mgll
Mn -Manganese 46565 u
Carbonate 445 mg/l
NH as N 610 m 11
Na - Sodium 46556 mg/1
Volatile Organics (VOA bottle)
Bicarbonate 440 m
—
TPH - Gasoline Range
Carbon dioxide 405 mgfl
`f
NO. + ND as N 630 In A
—
Pb - Lead 46564 u 11
TPH - BTEX Gasollre Range
"Chloride 940 mgA
P: Total as P 665 m A
Se - Selenium u n
Chromium: Hex 1032 u9A
n - Zinc 46567 u 11
Color: True 80 Cu
`7 r��
Cyanide 720 mgll
Lab Comments: '-D e6&_r'
Sw-54 nEv. 1^r For Dissolved Analysis - submit flitered s mple and write IDIS" in bit

:JfC CV'WQ La6oratory Section <.R§su{ts Sample ID AB31276
Location ID : RROAPNLC Collect Date: 06/12/2008
Loe. Descr.: BILL DYSON Collect Time :: 10:30
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Phosphorus_total as P In liquid 0.02 0.02 u mg/LasP MAJAYI MOVERMAN
Method Reference Lac1().115-01-1EF 6116108 6/19108
Nitrate as N In llquld 0.02 0 .02 u mg/LasN MOVERMAN MOVERMAN
Method Reference Lac:hat107-04-1-c 6118108 6118108
Nltrfte as N In llquld 0.01 0.01 u mg/LasN MOVERMAN MOVERMAN
Method Reference Lachat 107-04-1-c 6112/08 6118/08
MET
7429-90-5 AJbylCP 50 50 u ug/l DSTANLEY EST AFFORD
Method Reference EPA200.7 6/17/08 6/23/08
7440-70-2 CabylCP 0 .10 180 mg/I.. DSTANLEY ESTAFFORD
Method Reference EPA200.7 6/16108 6/23/08
7440-43-9 CdbylCPMS 1 .0 1.0 u ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6117/08 6/23108
7440-47-3 CrbylCPMS 10 10 u Ug/L SGOSS ESTAFFORD
Method Reference EPA200.8 6117/08 6/23108
7440-50-8 CubylCPMS 2.0 21 Ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7440-48-4 FebylCP 50 50 u ug/l DSTANLEY ESTAFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7439-95-4 MgbylCP 0.10 3.5 mg/I.. DSTANLEY ESTAFFORD
Method Reference EPA200.7 6116/08 6/23/08
7439-96-5 MnbylCP 10 34 ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7440-23-4 NabylCP 0.10 38 mg/L DSTAN LEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7440-02-0 NlbylCPMS 10 14 ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6117/08 6/23/08
7439-92-1 PbbylCPMS 10 10 u ug/l SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23108
7440-66-6 ZnbylCPMS 10 860 ug/L SGOSS EST AFFORD
Method Reference EPA 200.8 6117/08 6/23/08
--
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 3 of 3
Location ~D:
Loe. Descr.:
Visit ID
MIC
WET
NUT
RROAPNLC
BILL DYSON
CAS# Analyte Name
Sample temperature at receipt by tab
Method Reference
Collfoon, MF Fecal In Bquld
NC ClYWQ La6oratory Section <R.§sults
PQL Result Qualifier
3 .4
82
Method Reference APHA9222D-20th
Units
·c
CFU/100ml
Sample ID
Collect Date:
Collect Time::
Analyst/Date
DSAUNDERS
6112/08
PCOTTEN
6112 /08
Coliform, MF Total In llquld 5
Method Reference APHA9222B-20th ~~~ f'
CFU/100ml PCOTTEN
6/12/08
Alkallnlty to pH 4 .5 of llquld _TITLE_
Method Reference APHA2320B-20th
Alkallnlty4.5 70
Method Reference APHA2320B-20th
Alkallnlty8.3 1 u
Method Reference APHA2320B-20th
Bicarbonate 70
Method Reference APHA2320B-20th
Carbonate u
Method Reference APHA2320B-20th
pH_Alkallnlty 7 .35
Method Reference APHA2320B-20th
Ion Chromatography _TITLE_
Method Reference EPA 300 .0
Total DISSOived Solids In llquld 12 697
Method Reference APHA2540C-18TH
Ollorlde 1 .0 3.1
Method Reference EPA300.0
Fluoride 0.4 0.8
Method Reference EPA300.0
Sulfate 2 .0 420
Method Reference EPA300.0
NH3 as N In liquid 0.02 0 .02 U
Method Reference Lac10-107.06-1.J
Total Kjeldahl N as N In liquid 0.2 0.20 U
Method Reference Lacha\107-06-2-H
NO2+NO3 as N In liquid 0.02 0.02 U
Method Reference Lac10-107-04-1-c
Laboratory Section» 1623 Mall Serv ice Center, Raleigh, NC 27699-1623 [phone]
mg.IL as CaC03
mg/Las CaC03
mg.IL as CaC03
mg/L as CaCO3
mg/Las CaCO3
mg/Las CaC03
mg/L
mg/L
mg/L
mg/L
mg/I..
rng/LasN
mg/LasN
mg/LasN
NDEO
6/16 /08
NDEO
6/16/08
NDEO
6116 108
NDEO
6116108
NDEO
6/16108
ND EO
6116/08
MIBRAHIM1
6/19108
AWILUAMS
6/18108
MIBRAHIM1
6/19/08
MIBRAHIM1
6/19/08
MIBRAHIM1
6/19/08
MOVERMAN
6113/08
GBELK
6/19/08
MOVERMAN
61 13/08
Page 2 of 3
AB31276
06/12/2008
10:30
Approved By /Date
MMATHIS
6112/08
MOVERMAN
6117/08
MOVERMAN
6/17/08
MOVERMAN
6 120/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6/27108
MOVERMAN
6/23/08
MOVERMAN
6/27/08
MOVERMAN
6/27/08
MOVERMAN
6/27/08
CGREEN
6117/08
MOVERMAN
6/20108
CGREEN
6117108
County: ORANGE
River Basin d� ViA��R
Report To RROAP
Collector .! GREER C `C
Region: RRO
Sample Matrix: GROUNDWATER
Sample ID:
AB31276
PO Number #
8G0669
Date Received:
0611212008
Time Received:
12M
Labworks LoginfD
MMATHIS
Date Reported:
6127108
Loc. Type: WATER SUPPtY Report Generated' 0612712448
Emergency Yes1N❑ y iL}- VisiEl6
CQC Yes/No #
Loc. Descr.; RILL DYSDN
Location ID: RROAPNLC Collect Date: 0611212009 Collect Time:: 10:30 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A -Value reported is the average of two or more determinations
B1-Countable memtxanes with <20 colonies; Estimated
B2- Counts from all filters were zero-
8 - Countable membranes With more than 60 or 80 colonies; Estimated
B4-Filters have counts of both >60 or 80 and < 20; Estimated
B5-Too many colonies were present; too numerous to count (TNTC)
32- Reported value failed to meet OC criteria for either precision or acouracy; Estimated
J3-The sample matrix interfered wth the ability to make any accurate determinatiM Estimated
JS-The lab analysis was from an unpreserved or improperly 0emicaily preserved sample; Estimated
Nt-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
NVEstimated concentration is a POL and >MDL
NE -No established PQL
P-Elevated PQL due to matrix interference ansllor sample dilution
Qt-Holding time exceeded prior to receipt at lab.
Q2- Holding time exceeded following receipt by lab
PQL- Practical Qua ntitation Limil-subject to change due to instrument sensitivity
U- Samptes analyzed for this compound but not deterred
Xi- Sample not analyzed for this compound
Laboratory Section} 1623 Mail Service Center, Raleigh. NC 27699.1623 [phone] Page 1 of 3

RECEIVED r DENR i ❑Wig
{
JUL 3 2G6B Department of Environment and N Natural Resources
GROUNDWATER FIELDlLAB FORM DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County • -'s
Quad No Sd ial
Lat. Long.
No.
SAMPLE TYPE SAMPLE PRIORLLY
[ter routine
❑ Soil [ Emergency
❑ other
Report To: ARO, FRO, MRO RO aRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped try: B s, Courier4Han� d Del=.Other-
Collector(s)• ' Date & -2- ar Time
❑ Chain of Custody
Lab Number LzP' (OP r r-t:2 1 67-'� j
0 DateReceived 1' -u • u —Ti_ me lay
Ree'd by, From: Bus, Courier, an Del.,
Other:
Data Entry By: Ck:
Date Reported:
Compliance LUST, Pesticide Study, Federal Tru ;Others- �_—^��'`'
FIELQ ANA1-T, Et ' Owner
PHA _ 1.: � Spec. Cond.94 1 o at 250 C Location or site £Daa 1 :
Temp.16 .-jam oC Odor_ Description of sampling point r
Appearance Sampling Method Sa ple Interval
Field Analysis By: Remarks '
LABORATORY A LYSES (Puffob°`►.k�Imp, or)
Purpose:
Baseline,
BOD mo mqA
Dis . Solids 1=0
Ag - Silver 46566 u
COD High 340 mgfl
Flouride 951 m
'AI - Aluminum 4655T ugA
COD Low 335 m
l 9
As - Arsenic 48551 u
oliform: MF Fecal 31616 1100ml
Hardness non-carb 9[i2
Ba - Barium 46W u n
Conform: MF Total 31604 ltooml
Phenols 3273o ug8
Ca - Calcium 46552 miall
TOG Eno my
Spocific Cond. 95 whoskm2
Cd - CadMiUM 46559 u
Turbidity 76 NTU
Sulfate 945 rn 11
JCr - Chromium ONO ugA
Residue., Suspended 530 mglf
Sulfide 745 m Il
CU - Copper 46562 u
"Fe - Iron 4e563 ugA
Oil and Grease mail
H - Mercury 719M UgA
unit
K - Potassium 46555 I
Alkalinity to pH 4.5 410 mgA
M - Ma nesium 46554 mgA
Alkalinity to pH 8.3 415 mgli
Mn - Man anese 46565 UqA
Carbonate 445 mgll
H as N 610 moll
Na - Sodium 46556 m 11
Bicarbonate 440 m
Carbon dioxide 405 mgA
as N 6W MQA
'--'
Pb - Lead 46564 uqA
Chloride 94o mg1l
P: Total as P 665 m
- Selenium ugA
Chromium: Hex 1032 U
Zn - Zinc 46567 u n
Color. True 6o CU
r S —C.1.4 + �
Cyanide 720 MCI
n
Dr anochlorine Pesticides
Organophosphorus Pesticides
Nitro on Pesticides
Acid Herbicides
PCB's
Samivolatile Organics
TPH - Diesel Range
Volatile Organics (VOA battle)
TPH - Gasoline Range
TPH - OTEX Gasoline Range
GW,54 REV.1?- For Dissolved Analysis - submit filter sample and write"DIS" in bl,

¾C CVWQ La6oratory Section <.R.§su{ts Sample ID AB31275
Location ID : RROAPNLC Collect Date: 06/12/2008
Loe. Descr.: BILL DYSON Collect Time:: 10:00
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Phosphorus_total as P In liquid 0.02 0.02 u mg/LasP MAJAYI MOVERMAN
Method Reference Lac10-115-01-1EF 6/16/08 6/19/08
Nitrate as N In liquid 0.02 0.02 u mg/Las N MOVERMAN MOVERMAN
Method Reference Lachat107-04-1-c 6/18/08 6/18/08
Nttrtte as N In liquid 0.01 0.01 u mg/LasN MOVERMAN MOVERMAN
Method Refe,ence Lachat107.Q4-1-c 6/12/08 6/18/08
MET
7429-90-5 Al. by ICP 50 50 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/17/08 6/23/08
7440-70-2 Ca bylCP 0 .10 180 mg/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23108
7440-43-9 CdbylCPMS 1 .0 1.0 u ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7440-47-3 CrbylCPMS 10 10 u Ug/L SGOSS ESTAFFORD
Method Reference EPA200.8 6117/08 6/23/08
7440-50-8 CubylCPMS 2.0 23 Ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7440-48-4 FebylCP 50 55 Ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.7 6116/08 6/23/08
7439-95-4 MgbylCP 0 .10 3.6 mg/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7439-96-5 MnbylCP 10 34 ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.7 6/16/08 6/23/08
7440-23-4 NabylCP 0.10 38 mg/L DSTANLEY EST AFFORD
Method Reference EPA200.7 6116/08 6123108
7440-02-0 NlbylCPMS 10 17 ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23/08
7439-92-1 PbbylCPMS 10 10 u ug/L SGOSS EST AFFORD
Method Reference EPA200.8 6/17/08 6/23108
7440-66-6 ZnbylCPMS 10 1000 ug/L SGOSS ESTAFFORD
Method Reference EPA200.8 6117/08 6123108
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 3 of 3
location ID:
lee. Descr.:
Visit ID
MIC
WET
NUT
RROAPNLC
Bill DYSON
:NC CDWQ, La6oratory Section <R,gsu[ts Sample ID
Collect Date:
Collect nme::
GAS# Analyte Name PQL Result Qualifier Units Analyst/Date
Sample temperature at receipt by lab 2.1
Method Reference
Coliform, MF Fecal In liquid B2
Method Reference APHA9222D-20th
Coliform , MF To1al In liquid
Method Reference APHA9222B-20th
7 ;Jc..,21 .
(?,p---'fa.
Alkallnlty to pH 4.5 of liquid _TIT LE_
Method Reference APHA2320B-20th
Alkallnlty4.5 72
Method Reference APHA2320B-20th
Alkallnlty8.3 u
Method Reference APHA2320B-20th
Bicarbonate 72
Method Reference APHA2320B-20th
Carbonate u
Met hod Reference APHA2320B-20th
pH_Alkallnlty 7.6 6
Method Reference APHA2320B-20th
Ion Chromatography _mLE_
Method Reference EPA300.0
To1al Dissolved Solids In Uquld 12 7 00
Method Reference APHA2540C-18TH
Chloride 1.0 3.1
Method Reference EPA300.0
Fluoride 0.4 0.8
Method Reference EPA300.0
Sulfate 2.0 380
Method Reference EPA300.0
NH3 as N In liquid 0.02 0.02 u
Method Reference Lac10-107-06-1.J
Total Kjeldahl N as N In liquid 0 .2 0.2 0 u
Method Reference Lachat 107-06-2-H
N02+N03 as N In liquid 0.02 0.02 u
Method Reference Lac10-107-04-1-c
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
·c
CFUt100ml
CFU/100ml
mg/L as C8C03
mg/Las C8C03
mgfl as CaCO3
mg/L as CaC03
mgfl as CaC03
mg/Las CaC03
mg/L
mgfl
mg/I..
mg/L
mg/L
mgflas N
mg/Las N
mg/LasN
DSAUNDERS
6112108
PCOTTEN
6/12/08
PCOTTEN
6/12/08
NOEO
6/16/08
NDEO
6/16/08
NOEO
6/16/08
NDEO
6/16/08
NDEO
6/16/08
NDEO
6/16/08
MIBRAHIM1
6119/08
AWllLIAMS
6/18/08
MIBRAHIM1
6/19/08
MIBRAHIM1
6119/08
MIBRAHIM1
6119108
MOVERMAN
6/13/08
GBELK
6/19/08
MOVERMAN
6/13108
Page 2 of 3
AB31275
06/12/2008
10:00
Approved By /Date
MMATHIS
6112108
MOVERMAN
6/17/08
MOVERMAN
6117/08
MOVERMAN
6/20/08
MOVERMAN
6/20/08
MOVERMAN
6120/08
MOVERMAN
6120108
MOVERMAN
6/20108
MOVERMAN
6/20/08
MOVERMAN
6/27/08
MOVERMAN
6/23/08
MOVERMAN
6/27/08
MOVERMAN
6/27/08
MOVERMAN
6/27/08
CGREEN
6/17/08
MOVERMAN
6/20/08
CGREEN
6117/08
ZVQ Lafioratoa Section &sults
Counly
ORANGE
Sample ID:
AB31275
River Basin
F Ar
d R
�p
PO Number #
8GO668
Report To
RROAP
p�b4d
Data Received:
06/1212008
Collector,J
GREER ,
y
Time Received:
12:50
Region:
IRRO
tf r
Y
�d
Labworks LoginlD
MMATHIS
Sample Matrix:
GROUNDWATER
y, w r}t1ClC!
i� LUUU
Date Reported'
6127108
Loc. Type:
WATER SUPPLY
� � tll
Report Generated.
0612712008
Emergency YesfNo
Ct3C Yes/No
i4rLaiii�
�>�cNP.1'S�,t_ yl�r_._-•
t'1
Vsiti❑
�QQ
Loc. Descr,. BILL DYSON
Location ID:
RROAPNLC
Collect Date: OW1212008 Collect Time:: 14,00
Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A -Value reported is the average of two or more determinations
B1-Countable membranes with <20 colonies; Estimated
82- Counts from all fillers ware zero.
B3- Countable membranes wish more than 60 or 80 colonies; Estimated
B6-Filters have counts of both >60 or 90 and < 20; Estimated
85-Too many colonies were present; too numerous to taunt (TNTC)
J2- Reported value failed to meet QC criteria for either precasion or accuracy; Estimated
J3 The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis eras from an unpreserve l or improperly chemically preserved sample; F_stimaled
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
N3-Estimated concentration is 4 POL and >MDL
NE -No established POL
P-Elevated POL due to matrix interference and/or sample dilution
QI-Holding time exceeded prior to receipt at lab,
42- Holding lime exceeded following receipt by lab
PQL- Practical Qua nthation Limit -subject to change due to instrument sensitivity
U- Samples analyzed for this compound but not detected
XI- Sample not analyzed for this compound
Laboratory 5ectloni> 1623 Mali Service Center, Raleigh, NC 21699-1623 [phone] Page l of 3